10 Rekp Permintaan & Penerimaan Gab III BPJS I OKT'20

DAFTAR PENERIMA JASA MEDIS BPJS I, SPM & JAMPERSAL (PROPORSIONAL 60%)
BULAN : OKTOBER 2020

VISITE KONSUL
NO NAMA RUANGAN AKOMUDASI TINDAKAN ASKEP /ASGIZ DR. ONSITE/
DR. UMUM ON CALL
SPESIALIS ANTAR POLI
1 Dr. Chusnul Ghaib, SpB OK BEDAH - 12,226,896 - - - - -
2 Dr. Sulistyawan, SpOT OK ORTOPEDI - - - - - - -
3 Dr. Ali Rahman, SpOG OK OBGYN - 4,371,840 - - - - -
4 Wedi ANST BEDAH - - - - - - -
5 Sugianto ANST ORTOPEDI - - - - - - -
6 Mugiaman ANEST OBGYN - - - - - - -
7 H. Abd Kholik S RR (PULIH SADAR) - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
8 Yuliastri, Amd. Kep R. ANAK - 1,469,788 1,648,053 29,700 1,612,710 - -
VISITE KONSUL
DR. UMUM ON CALL
9 Hj. Rukayyah, Amd. Keb R. KAND & KEBIDANAN - 2,249,834 252,153 - 267,300 - 306,900
R. VK BERSALIN - - - - - - -
VISUM R. VK - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
10 H. Moh. Kamim, S.Kep.NS R.BEDAH - 2,017,729 678,942 389,070 778,140 128,700 9,900
VISITE KONSUL
DR. UMUM ON CALL
11 H. Imam Muslim, S.Kep.Ns R.INTERNE - 761,068 224,532 38,610 273,240 29,700 9,900
ECK R. INTERNE - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
12 Nurus Syamsi, s.Kep.Ns IRD 1,716,422 5,096,977 1,063,260 1,330,560 - 148,500 1,232,550
RETRIBUSI IRD - - - - - - -
EKG IRD - - - - - - -
VISUM IRD - - - - - - -
13 Abdullah Muchlis, Amd.Kep OK IRD (III) - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
14 Ali Achmad, S.Kep.Ns R. ICU - 443,498 237,600 29,700 151,470 49,500 59,400
EKG R. ICU - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
15 Hj. Sri Astutik. S.Kjep.Ns R. NICU/PICU - 700,308 665,280 29,700 959,310 49,500 59,400
VISITE KONSUL
DR. UMUM ON CALL
16 Endang Astikowati, Amd.Rad INST. RADIOLOGI 7,197,106 - - - - - -
USG RADIOLOGI - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
17 Nurul Herlina INST. LABORATORIUM 5,806,798 - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
18 Endang Tegowati, Amd. Kep P. ANAK 124,740 - - - - - -
RETRIB. P. ANAK - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
19 Hj. Tajun Nisak, S.Kep.Ns P. KANDUNGAN 231,660 208,963 - - - - -
RETRIB. P. KANDUNGAN - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
20 Hj. Sumartini, Amd.Kep P. INTERNE 424,710 - - - - - -
RETRIB. P. INTERNE - - - - - - -
EKG P. INTERNE - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
21 Listriyaningsih, Amd.Kep P. BEDAH 772,200 178,200 - - - - -
RETRIB. P. BEDAH - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
22 Pritta Sahadatina, Amd.Kes.Gi P. GIGI 106,920 163,344 - - - - -
RETRIB. P. GIGI - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
32 Dr. Novia I Adisty, Sp.K P. KULIT & KELAMIN 374,220 - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
23 H.M.N. Budi Santoso, S.Kep.Ns P. MATA 400,950 174,636 - - - - -
RETRIB. P. MATA - - - - - - -
OK MATA - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
24 Nanang Heru S, Amd.Fis REHAB MEDIK 172,260 629,616 - - - - -
RETRIB. REHAB MEDIK - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
25 Sumiyati, Amd.Kep P. SYARAF 513,810 - - - - - -
EEG - - - - - - -
RETRIB. P. SYARAF - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
26 Hj. Cicik Ernaningsih, Amd.Kep P. THT 1,078,110 1,164,269 - - - - -
RETRIB. P. THT - - - - - - -
OK THT - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
27 Mafrudah, Amd.Kep P. HEMODIALISA - - - - - - -
RETRIB. P. HD - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
28 Hj. Ririn Satariyah, S.Kep Ns P. KUK 225,720 166,795 - - - - -
VISITE KONSUL
DR. UMUM ON CALL
29 Syamsul Arifin INST. PEM JENAZAH 75,443 - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
30 Hairunnisak,Amd.Gz INST. GIZI 187,214 - 141,372 - - - -
VISITE KONSUL
DR. UMUM ON CALL
31 Wartatik Wardaningsih, Amd.KL INCENERATOR - - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
32 Rafidatul Riskiyah, Amd.Kep VCT 77,220 - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
32 Nur Hidayat, Amd.Kep P. JIWA 141,075 677,160 - - - - -
VISITE KONSUL
DR. UMUM ON CALL
32 Ike Wulandari, A.Md.Kep P. PARU 617,760 - - - - - -
VISITE KONSUL
DR. UMUM ON CALL
32 Endang Wulandari, A.Md.Kep P. JANTUNG 121,770 130,673 - - - - -
VISITE KONSUL
DR. UMUM ON CALL
32 Hj. Ermawati, S.Kep.Ns R. DAHLIA - 1,912,258 1,140,480 - 959,310 495,000 -
VISITE KONSUL
DR. UMUM ON CALL
32 Sigit Setiawan GRIU - 9,783,079 6,177,600 727,650 8,788,230 287,100 153,450
VISITE KONSUL
DR. UMUM ON CALL
32 Liza Wulandari,S.Farm, Apt INST. FARMASI 1,676,999 - - - - - -
34 Suryo Kusumo PMI 3,118,500 - - - - - -
35 Hj. Ririn Satariyah, S.Kep Ns BIDANG DIKLAT - - - - - - -
JUMLAH 25,161,608 44,526,933 12,229,272 2,574,990 13,789,710 1,188,000 1,831,500
23,914,208 44,526,933 12,229,272 2,574,990 13,789,710 1,188,000 1,831,500
1,247,400 - - - - - -
OXYGEN JUMLAH
- 12,226,896
- -
- 4,371,840
- -
- -
- -
- - 16,598,736
OXYGEN JUMLAH
- 4,760,251 4,760,251
OXYGEN JUMLAH
- 3,076,187
- -
- -
OXYGEN JUMLAH
- 4,002,481
OXYGEN JUMLAH
- 1,337,050
- -
OXYGEN JUMLAH
- 10,588,270
- -
- -
- -
- -
OXYGEN JUMLAH
- 971,168
- -
OXYGEN JUMLAH
1,097,910
- 2,463,498 1,365,588
OXYGEN JUMLAH
- 7,197,106
- -
OXYGEN JUMLAH
- 5,806,798
OXYGEN JUMLAH
- 124,740
- -
OXYGEN JUMLAH
- 440,623
- -
OXYGEN JUMLAH
- 424,710
- -
- -
OXYGEN JUMLAH
- 950,400 950,400
- -
OXYGEN JUMLAH
- 270,264
- -
OXYGEN JUMLAH
- 374,220
OXYGEN JUMLAH
- 575,586
- -
- -
OXYGEN JUMLAH
- 801,876 801,876
- -
OXYGEN JUMLAH
- 513,810
- -
- -
OXYGEN JUMLAH
- 2,242,379 2,242,379
- -
- -
OXYGEN JUMLAH
- - -
- -
OXYGEN JUMLAH
- 392,515
15,000
OXYGEN JUMLAH
250,000
- 75,443 280,000
80,000
61,070
686,070
OXYGEN JUMLAH
- 328,586
OXYGEN JUMLAH
- -
OXYGEN JUMLAH
- 77,220
OXYGEN JUMLAH
- 818,235
OXYGEN JUMLAH
- 617,760
OXYGEN JUMLAH
- 252,443
OXYGEN JUMLAH
- 4,507,048
OXYGEN JUMLAH
- 25,917,109
OXYGEN JUMLAH
- 1,676,999
- 3,118,500
- -
- 101,302,013
- 3,118,500
-
DAFTAR PENERIMA JASA MEDIS BPJS I, SPM & JAMPERSAL
RSUD Dr. H. MOH. ANWAR KAB. SUMENEP
VISITE KONSUL
N ASKEP
NAMA RUANGAN AKOMUDASI TINDAKAN DR. ONSITE/ OXYGEN
O /ASGIZ DR. UMUM ON CALL
1 Yuliastri, Amd. Kep R. ANAK - 2,449,646 2,746,755 49,500 2,687,850 - - -

2 H. Moh. Kamim, S.Kep.NS R. BEDAH - 3,362,882 1,131,570 648,450 1,296,900 128,700 9,900 -
R. INTERNE - 1,268,447 374,220 64,350 455,400 29,700 9,900 -
3 H. Imam Muslim, S.Kep.Ns
EKG R. INTERNE - - - - - - - -
Hj. Ermawati, S.Kep.Ns R. DAHLIA - 3,187,097 1,900,800 - 1,598,850 495,000 - -
4 Hj. Sri Astutik. S.Kjep.Ns R. NICU/PICU - 1,167,180 1,108,800 49,500 1,598,850 49,500 59,400 -
R. KAND & KEBIDANA - 3,749,724 420,255 - 445,500 - 306,900 -
5 Hj. Rukayyah, Amd. Keb R. VK BERSALIN - - - - - - - -
VISUM R. VK - - - - - - - -
R. ICU - 739,164 396,000 49,500 252,450 49,500 59,400 -
6 Ali Achmad, S.Kep.Ns
EKG R. ICU - - - - - - - -
IRD 2,860,704 8,494,962 1,772,100 2,217,600 - 148,500 1,232,550 -
RETRIBUSI IRD - - - - - - - -
7 Nurus Syamsi, s.Kep.Ns
EKG IRD - - - - - - - -
VISUM IRD - - - - - - - -
Abdullah Muchlis, Amd.Kep OK IRD (III) - - - - - - - -
Sigit Setiawan GRIU - 16,305,132 10,296,000 1,212,750 14,647,050 287,100 153,450 -
- - - - - - - -
8 Nurul Herlina INST. LABORATORIUM 9,677,997 - - - - - - -
INST. RADIOLOGI 11,995,177 - - - - - - -
9 Endang Astikowati, Amd.Rad
USG RADIOLOGI - - - - - - - -
10 Dr. Chusnul Ghaib, SpB OK BEDAH - 20,378,160 - - - - - -
11 Dr. Sulistyawan, SpOT OK ORTOPEDI - - - - - - - -
12 Dr. Ali Rahman, SpOG OK OBGYN - 7,286,400 - - - - - -
13 Wedi ANST BEDAH - - - - - - - -
14 Sugianto ANST ORTOPEDI - - - - - - - -
15 Mugiaman ANEST OBGYN - - - - - - - -
16 H. Abd Kholik S RR (PULIH SADAR) - - - - - - - -
17 Hairunnisak,Amd.Gz INST. GIZI 312,023 - 235,620 - - - - -
P. HEMODIALISA - - - - - - - -
18 Mafrudah, Amd.Kep
RETRIB. P. HD - - - - - - - -
REHAB MEDIK 287,100 1,049,359 - - - - - -
19 Nanang Heru S, Amd.Fis
RETRIB. REHAB MEDIK - - - - - - - -
20 Liza Wulandari,S.Farm, Apt INST. FARMASI 2,794,999 - - - - - - -
21 Syamsul Arifin INST. PEM JENAZAH 125,738 - - - - - - -
22 Suryo Kusumo AMBULANCE/PMI 3,118,500 - - - - - - -
23 Wartatik Wardaningsih, Amd.K IPAL - - - - - - - -
24 Erlin Suprapti, Amd. KL LAUNDRY - - - - - - - -
25 Hj. Ririn Satariyah, S.Kep Ns KONSULTASI DIKLAT - - - - - - - -
- - - - - - - -
P. ANAK 207,900 - - - - - - -
26 Endang Tegowati, Amd. Kep
RETRIB. P. ANAK - - - - - - - -
P. KANDUNGAN 386,100 348,272 - - - - - -
27 Hj. Tajun Nisak, S.Kep.Ns
RETRIB. P. KANDUNG - - - - - - - -
P. INTERNE 707,850 - - - - - - -
28 Hj. Sumartini, Amd.Kep RETRIB. P. INTERNE - - - - - - - -
EKG P. INTERNE - - - - - - - -
P. GIGI 178,200 272,240 - - - - - -
29 Pritta Sahadatina, Amd.Kes.Gi
RETRIB. P. GIGI - - - - - - - -
P. BEDAH 1,287,000 297,000 - - - - - -
30 Listriyaningsih, Amd.Kep
RETRIB. P. BEDAH - - - - - - - -
P. MATA 668,250 291,060 - - - - - -
31 H.M.N. Budi Santoso, S.Kep.NsRETRIB. P. MATA - - - - - - - -
OK MATA - - - - - - - -
P. THT 1,796,850 1,940,449 - - - - - -
32 Hj. Cicik Ernaningsih, Amd.Ke RETRIB. P. THT - - - - - - - -
OK THT - - - - - - - -
P. SYARAF 856,350 - - - - - - -
33 Sumiyati, Amd.Kep EEG - - - - - - - -
RETRIB. P. SYARAF - - - - - - - -
34 Marsuki, S.Sos POLI GIZI - - - - - - - -
35 Hj. Ririn Satariyah, S.Kep Ns P. KUK 376,200 277,992 - - - - - -
36 Rafidatul Riskiyah, Amd.Kep VCT 128,700 - - - - - - -
37 Nur Hidayat, Amd.Kep P. JIWA 235,125 1,128,600 - - - - - -
38 Endang Wulandari, A.Md.Kep P. JANTUNG 202,950 217,789 - - - - - -
39 Ike Wulandari, A.Md.Kep P. PARU 1,029,600 - - - - - - -
40 Nurul Izzati, Amd. Kep P. KULIT & KELAMIN 623,700 - - - - - - -
41 Harmonisasi Harmonisasi - - - - - - - -
JUMLAH 39,857,013 74,211,555 20,382,120 4,291,650 22,982,850 1,188,000 1,831,500 -
Dana Kesehatan 1% 1,664,088
166,408,776
Jaspel 99% 164,744,688
Mengetahui Sumenep, 10 Peb
Direktur RSUD dr. H. Moh. Anwar Tim Pembagi Jasa Bendahara Peng
dr. ERLIYATI, M.Kes dr. ABDUL AZIZ, Sp. Rad

NIP. 19700722 200012 2 003 NIP. 19700403 200501 1 014 NIP. 19840416 20
-
JUMLAH TANDA TANGAN
7,933,751 1 7,933,751 7,933,751 -

6,578,402 2 6,578,402 6,578,402 -
2,202,017 2,202,017 2,202,017 -
3
-
7,181,747 7,181,747 7,181,747 -
4,033,230 4 4,033,230 4,033,230 -
4,922,379 4,922,379 4,922,379 -
- 5
-
1,546,014 1,546,014 1,546,014 -
6
-
16,726,416 16,726,416 16,726,416 -
-
7
-
-
-
42,901,482 - 42,901,482
9,677,997 8 9,677,997 9,677,997 -

11,995,177 11,995,177 11,995,177 -
9
-
20,378,160 10 20,378,160 20,378,160 -
- 11 - - -
7,286,400 12 7,286,400 7,286,400 -
- 13
- 14
- 15
- 16
547,643 17 547,643 547,643 -
- - - -
18
-
1,336,459 1,336,459 1,336,459 -
19
-
2,794,999 20
125,738 21 125,738 125,738 -
3,118,500 22
- 23 - - -
- 24
- 25 - - -
207,900 207,900 207,900 -

26
-
734,372 734,372 734,372 -
27
-
707,850 707,850 707,850 -
- 28
-
450,440 450,440 450,440 -
29
-
1,584,000 1,584,000 1,584,000 -
30
-
959,310 959,310 959,310 -
- 31
-
3,737,299 3,737,299 3,737,299
- 32
-
856,350 856,350
- 33
- 856,350
- 34
654,192 35
128,700 36
1,363,725 37
420,739
1,029,600 38
623,700 39
-
164,744,688
164,744,688
Sumenep, 10 Pebruari 2021

Bendahara Pengeluaran
I B N U, S. AN
NIP. 19840416 201001 1 008
PORSI PEMBAGIAN
60% 40% 20%
60% 40%
NO NAMA RUANG PROP KOLEKTIF BBA
Dr. Tabrani, SpB 6,547,503 4,365,002

1 OK BEDAH
Prmedis OK Bedah 2,182,501 1,455,001
Dr. Sulistyawan, SpOT - -

2 OK ORTOPEDI
Prmedis OK Bedah - -
Dr. Ali Rahman, SpOG 2,341,120 1,560,747
3 OK OBGYN
Prmedis OK Obgyn 780,373 520,249
Dr. Tabrani, SpB 944,161 629,441

4 ANAST BEDAH
Wedi 2,552,731 1,701,821
Dr. Sulistyawan, SpOT - -

5 ANAST ORTOPEDI
Sugianto - -
Dr. Ali Rahman, SpOG 337,593 225,062
6 ANST OBGYN
Mugiaman 912,753 608,502
Dr. Tabrani, SpB - -

7 ANST IRD (OK IRD)
H. Abd Kholik S - -
8 H. Abd Kholik S RR - -
Dr. Dian Marcia, Sp.A 1,642,410 1,094,940
9 R. ANAK
Prmedis R. Anak 3,117,841 2,078,560
Dr. Ali Rahman 574,200 178,200
10 R. KABER / VK
Prmedis R. Kaber/VK 2,501,987 1,667,992
Dr. Tabrani, SpB (Tim Dr) 1,305,810 778,140
11 R. BEDAH
Prmedis R. Bedah 2,696,671 1,797,781
Dr.H.M.Mujib, SpPD (Tim Dr) 351,450 207,900
12 R. INTERNE
Prmedis R. Interne 985,600 657,067
Medis 1,454,310 639,540

12 R. DAHLIA
Prmedis R. Interne 3,052,738 2,035,159
Dr. Suhartinah ( Tim Dr ) 2,711,610 887,040

13 IRD
Prmedis IRD 7,876,660 5,251,107
Dr. Tabrani, SpB - -

14 OK IRD (III)
Prmedis IRD - -
Medis 9,956,430 6,343,920
14 GRIU
Prmedis Griu 15,960,679 -
Dr.H.M.Mujib, SpPD (Tim Dr) 290,070 120,780
15 R. ICU
Prmedis ICU 681,098 454,065
Dr. Dian Marcia, Sp.A 1,097,910 659,340

16 R. NICU/PICU
16 R. NICU/PICU
Prmedis NICU/PICU 1,365,588 910,392
Dr.LAILA Sp Rad 2,878,842 1,919,228

17 INST. RADIOLOGI
Endang Astikowati, Amd.Rad 4,318,264 2,878,842
Dr. Hj. Itha FirdariniSp.PK 1,974,311 1,316,208

18 INST. LABORAT
Analis Laborat 3,832,487 2,554,991
Dr. Dian Marcia, Sp.A 49,896 33,264

19 P. ANAK
Prmedis P. Anak 74,844 49,896
Dr. Ali Rahman SpOG 176,249 117,500

20 P. KANDUNGAN
Prmedis P.Kandungan 264,374 176,249
Dr. H.Moh. Mujib H 169,884 113,256

21 P. INTERNE
Prmedis P. Interne 254,826 169,884
Dr. H. M. Rizal S, SpB 712,800 475,200

22 P. BEDAH
Prmedis P. Bedah 237,600 158,400
Drg. H. Irfan Zuhri 102,700 68,467

23 P. GIGI
Prmedis P. Gigi 167,564 111,709
Dr. H. Karnedi H 345,352 230,234

24 P. MATA
Prmedis P.Mata 230,234 153,490
25 Nanang Heru S, Amd.Fis P. REHAB MEDIK 801,876 534,584

Sumiyati, Amd.Kep 282,596 188,397
26 P. SYARAF
Prmedis P. Syaraf 231,215 154,143
Dr. Diah P , Sp. THT 1,121,190 747,460

27 P. THT
Prmedis P.THT 1,121,190 747,460
Dr. Moh Mujib ,SpPD - -

28 P. HEMODIALISA
Prmedis P. HD - -
Dr. Suhartinah 137,380 91,587

29 P. KUK
Prmedis P. KUK 255,135 170,090
30 Rafidatul Riskiyah, Amd.Kep VCT 77,220 51,480
31 Dr. Utomo, SpJ P. JIWA 818,235 545,490
32 Dr. Amir Faisal, Sp.JP P. JANTUNG 252,443 168,296
33 Dr. Utomo, SpJ P. PARU 617,760 411,840
34 Dr. Utomo, SpJ P. KULIT & KELAMIN 374,220 249,480
35 Syamsul Arifin INST. PEM JENAZAH 75,443 50,295
36 Hairunnisak,Amd.Gz INST. GIZI 328,586 219,057

37 Wartatik Wardaningsih IPAL - -
38 Sri Hidayati, Amd.farm INST. FARMASI 1,676,999 1,117,999
39 Suryo Kusumo PMI/AMBULANCE 3,118,500
40 Hj. Ririn Satariyah, S.Kep Ns Bidang Diklat -
41 Harmonisasi -
JUMLAH 98,183,513 52,802,223 3,118,500
52,802,223
JAPEL 154,104,236
DATA 164,744,688
KONTROL 150,985,736
DIBAGIKAN KE DIREKSI & TAKTIS 13,200,556 -
KE UNIT PENGHASIL LANGSUNG 98,183,513 86,930,314 -11,253,198.52
KE UNIT PENGHASIL TAK LANGSUNG 39,601,667 PROSENTASE UNTUK KOLEKTIF

JUMLAH JASPEL 150,985,736 KOLEKTIF
BBA 100% 3,118,500 RINCIAN 30.0%
ADM 100% - Dokter 4.15%
Jasa Incenerator Paramedis 16.90%
Jasa Konsultasi Gizi Non Medis 7.55%
JasaPemulasaraan Jenazah Tim IPCN 0.30%
Jasa Konsultasi Diklat - Pembagi 0.35%
JUMLAH TOTAL 154,104,236 Tim Admin Jasa 0.75%
Kelompok I 30.00%
PAJAK
NO NAMA GoL JENIS JASA BRUTO
5% dan 15%
1 Jamali, S.Si, M.Kes IV Direksi 13,200,556 1,240,648

2 Dr. Siti Fatimah IV Kolektif Dokter 5,478,231 429,587
3 SURATINAH, SST III Tim IPCN 396,017 19,801
4 Dr. ABDUL AZIS, Sp.Rad III Tim Pembagi Jasa 462,019 23,101
5 Suryo Kusumo III Tim Administrasi Jasa 990,042 49,502
6 Hj. Ririn Satariyah, S.Kep Ns III Bidang-Diklat - -
JUMLAH 20,526,864 1,762,638
KOREKSI REKAP
NO URAIAN BRUTO PAJAK NETTO
1 Kelompok I 20,526,864 1,762,638 18,764,226

2 Kel. Reveneu (Kel. II ) Proporsional 86,930,314 4,433,059 82,497,255
3 Kel. Reveneu (Kel. II ) Kolektif #REF! #REF! #REF!
4 Kel. Non Reveneu ( Kel. III ) #REF! #REF! #REF!
5 Pembulatan - -
TOTAL JASPEL 154,104,236 #REF! #REF! #REF!
KONTROL #REF!
-
-
-
90% 90% 10% 16,598,736 16,598,736
80% 100% 75% 25% 27,664,560 27,664,560
60% 30% 10%
ADM JUMLAH PROPORSI KOLEKTIF DIREKSI JUMLAH Kontribusi Jaspel
6,547,503 3,273,751 1,091,250 10,912,505
14,550,006
2,182,501 1,091,250 363,750 3,637,502
11.02%
- - - -
-
- - - -
2,341,120 1,170,560 390,187 3,901,867

5,202,490 3.9%
780,373 390,187 130,062 1,300,622
1,573,602 944,161 472,080 157,360 1,573,602
4,254,552 2,552,731 1,276,366 425,455 4,254,552
- - - - -
- - - - -
562,656 337,593 168,797 56,266 562,656 5.99%

1,521,255 912,753 456,376 152,125 1,521,255
- - - - -
- - - - -
- - - - -
1,642,410 821,205 273,735 2,737,350

7,933,751 6.0%
3,117,841 1,558,920 519,640 5,196,401
574,200 133,650 44,550 752,400

4,922,379 3.5%
2,501,987 1,250,994 416,998 4,169,979
1,305,810 583,605 194,535 2,083,950

6,578,402 4.9%
2,696,671 1,348,335 449,445 4,494,452
351,450 155,925 51,975 559,350

2,202,017 1.6%
985,600 492,800 164,267 1,642,667
1,454,310 479,655 159,885 2,093,850

7,181,747 5.1%
3,052,738 1,526,369 508,790 5,087,897
2,711,610 665,280 221,760 3,598,650

16,726,416 11.6%
7,876,660 3,938,330 1,312,777 13,127,766
- - - -
- 0.0%
- - - -
9,956,430 4,757,940 1,585,980 16,300,350
32,261,029 12.0%
15,960,679 - - 15,960,679
290,070 90,585 30,195 410,850
1,546,014 1.1%
681,098 340,549 113,516 1,135,164
1,097,910 494,505 164,835 1,757,250

4,033,230 3.0%
4,033,230 3.0%
1,365,588 682,794 227,598 2,275,980
2,878,842 1,439,421 479,807 4,798,071

11,995,177 9.1%
4,318,264 2,159,132 719,711 7,197,106
1,974,311 987,156 329,052 3,290,519

9,677,997 7.3%
3,832,487 1,916,243 638,748 6,387,478
49,896 24,948 8,316 83,160

207,900 0.2%
74,844 37,422 12,474 124,740
176,249 88,125 29,375 293,749

734,372 0.6%
264,374 132,187 44,062 440,623
169,884 84,942 28,314 283,140

707,850 0.5%
254,826 127,413 42,471 424,710
712,800 356,400 118,800 1,188,000

1,584,000 1.2%
237,600 118,800 39,600 396,000
102,700 51,350 17,117 171,167

450,440 0.34%
167,564 83,782 27,927 279,273
345,352 172,676 57,559 575,586

959,310 0.7%
230,234 115,117 38,372 383,724
1,336,459 801,876 400,938 133,646 1,336,459 1.01%

282,596 141,298 47,099 470,993
856,350 0.6%
231,215 115,607 38,536 385,358
1,121,190 560,595 186,865 1,868,649

3,737,299 2.8%
1,121,190 560,595 186,865 1,868,649
- - - -
- 0.0%
- - - -
137,380 68,690 22,897 228,967

654,192 0.50%
255,135 127,567 42,522 425,225
128,700 77,220 38,610 12,870 128,700 #DIV/0!
1,363,725 818,235 409,118 136,373 1,363,725 #DIV/0!
420,739 252,443 126,222 42,074 420,739
1,029,600 617,760 308,880 102,960 1,029,600 #DIV/0!
623,700 374,220 187,110 62,370 623,700 #DIV/0!
125,738 75,443 37,721 12,574 125,738 0.10%
547,643 328,586 164,293 54,764 547,643 0.41%
- - - - - 0.00%
2,794,999 1,676,999 838,500 279,500 2,794,999 2.12%
3,118,500 - - - - 0.00%
- - - - - 0.00%
- - -
- 154,104,236 98,183,513 39,601,667 13,200,556 150,985,736 #DIV/0!
154,104,236 39,601,667 150,985,736
DATA 164,744,688 65.0% 26.2% 8.7% 100%
KEU
KOREKSI 10,640,453 KOREKSI 120,492,452 TT KEL 2
F JML JASPEL DIREKSI JML JASPEL

100.0% 39,601,667 RINCIAN 10.0% 100.00% 13,200,556 Harmonisasi (Rp)
13.8% 5,478,231 Direksi 7.0% 70.00% 9,240,389 -
56.3% 22,308,939 HR & Operasional 3.0% 30.00% 3,960,167 -
25.2% 9,966,420 -
1.0% 396,017 -
1.2% 462,019
2.5% 990,042
-
KOREKSI 39,601,667
JUMLAH 37,753,589 Remun Gabungan
NETTO
11,959,908
5,048,644
376,216
438,918
940,540
-
18,764,226
8,151,264
2,914,560
11,065,824
16,598,736
1 0% _ 10%
2 10,1% - 20%
3 20,1% - 30%
4 30,1% - 40%
5 40,1% - 50%
6 50,1% - 60%
7 60,1% - 70%
8 70,1% - 80%
9 80,1% - 90%
10 90,1% - 100%
4,033,230
% 0.10%
14.5% 4.150% 0.10% 4.05%
59.1% 16.900% 0.10% 16.80%
26.4% 7.550% 0.10% 7.45%
100.0% 0.30%
0.750% 0.75%
0.000% 0.00%
29.350% 0.300000% 29.35%
KELOMPOK 1
No Nama Gol Jenis Jasa BPJS I SPM JAMPERSAL JASA RAHARJA Jumlah Bruto
1 Jamali, S.Si, M.Kes IV Menejemen 15,860,669 15,860,669

2 Dr. Siti Fatimah III Kolektif Dokter 6,582,178 6,582,178
4 Hj, Suratinah III Tim IPCN 475,820 475,820
5 dr. Abdul Azis, Sp. Rad III Tim Pembagi Jasa 555,123 555,123
3 Suryo Kusumo III Tim Administrasi Jasa 1,189,550 1,189,550
6 Hj. Ririn Satariyah, S.Kep III Konsultasi Diklat - -
7 dr. Abdul Azis, Sp. Rad Dana Kesehatan 1,664,088 1,664,088
JUMLAH 26,327,428 - - - 26,327,428
Mengetahui
Direktur RSUD dr. H. Moh. Anwar Tim Pembagi Jasa

NIP. 19700722 200012 2 003 NIP. 19700403 200501 1 014
REKAPITULASI
Uraian BPJS I SPM JAMPERSAL JASA RAHARJA Jumlah Bruto
1 Kelompok 1 26,327,428 26,327,428
2 Kel. Reveneu ( Kel. 2 ) Proporsional 98,183,513 98,183,513
3 Kel. Reveneu ( Kel. 2 ) Kolektif 26,804,530 - 26,804,530
4 Kel. Non Reveneu ( Kel.3 ) 11,974,805 - 11,974,805
5 Pembulatan - -
JUMLAH 163,290,276 - - - 163,290,276

1,246,873
Mengetahui 266,997
Direktur RSUD dr. H. Moh. Anwar 161,776,407 Tim Pembagi Jasa

NIP. 19700722 200012 2 003 NIP. 19700403 200501 1 014
AMPERSAL
EP
Pajak Netto Tanda Tangan
1,240,648 14,620,021 1
429,587 6,152,591 2
475,820 5
49,543 505,580 6
59,478 1,130,073 3
- - 7
1,664,088 7
1,779,255 24,548,173

dr. ABDUL AZIZ, Sp. Rad I B N U, S. AN

NIP. 19700403 200501 1 014 NIP. 19840416 201001 1 008
AMPERSAL
Pajak Jumlah Netto KETERANGAN
1,779,255 24,548,173 26,327,428 -
4,433,059 82,507,255 98,183,513 -

Pajak hanya
dikenakan pada
1,094,943 25,709,587 26,804,530 -
Karyawan Gol III
dan Gol IV
173,430 11,801,375 11,974,805 -
- - - -
7,480,688 144,566,390 163,290,276 - KONTROL

dr. ABDUL AZIZ, Sp. Rad I B N U, S. AN

NIP. 19700403 200501 1 014 NIP. 19840416 201001 1 008
REKAP JUMLAH DANA YANG DIBAGI
NO NAMA JENIS JASA BPJS I SPM JAMPERSAL JML BRUTO
1 Salamet Hariyadi (daftar terlampir) 142,070,069 - - 142,070,069

Kolektif Dokter 6,354,094 - - 6,354,094
Kel Paramedis 26,804,530 - - 26,804,530
Kel. Non Medis 11,974,805 - - 11,974,805
Prop. Ruangan 96,936,641 - - 96,936,641
-
2 Unik W Konsultasi-Diklat - - - -
3 PMI - - - -
4 Menejemen 15,860,669 - - 15,860,669
5 Hj, Suratinah Tim IPCN 475,820 - - 475,820
6 dr. Abdul Azis, Sp. Rad Tim Pembagi Jasa 555,123 - - 555,123
7 Suryo Kusumo Tim Administrasi Jasa 1,189,550 - - 1,189,550
8 Dr. Abdul Aziz, Sp. Rad Dana Kesehatan 1,664,088 - - 1,664,088
JUMLAH 161,815,320 - - 161,815,320
1,474,956 - -
163,290,276.00
Mengetahui
Direktur RSUD dr. H. Moh. Anwar Pejabat Teknis
dr. ERLIYATI, M.Kes Dr. DIAN MARCIA, Sp.A

NIP. 19700722 200012 2 003 NIP. 19660627 199703 2 001
RSAL
PAJAK TOTAL NETTO TANDA TANGAN
6,131,019 135,939,050 1 135,939,050 46,878,102

429,587 5,924,507 45,133,429 45,133,429 (228,084)
1,094,943 25,709,587 -
173,431 11,801,374 -
4,433,059 92,503,581 10,006,326 (1,246,872)
- - 2 -
- 3 -
1,240,648 14,620,021 4
23,791 452,029 5
49,543 505,580 6
59,478 1,130,072 7 (10,006,326.07)
1,664,088 8
7,504,479 154,310,840 163,329,189 1,513,869 (1,474,956)

Ketua Tim Pembagi Jasa
dr. ABDUL AZIZ, Sp. Rad Hj, Suratinah 226,015

NIP. 19700403 200501 1 014 Fredy s 226,015
452,029
I B N U, S. AN
NIP. 19840416 201001 1 008
TOTAL
NO JENIS JASA PERSENTASE REMUNERASI
KONSUL TOTAL BRUTO
A. DANA KESEHATAN 1% 1,664,088 1,664,088

B. JASA REMUNERASI
1 Proporsional/Intensif Unit Penghasi 60% 93,917,141 3,019,500 96,936,641
2 Jasa Medis Proporsional 30% 47,353,923 47,353,923
- Tenaga Medis 4.20% 6,354,094 6,354,094
- Tenaga Paramedis 16.95% 26,804,530 26,804,530
- Non Penghasil 7.60% 11,974,805 11,974,805
- Tim IPCN 0.02% 475,820 475,820
- Tim Pembagi Jasa 0.30% 555,123 555,123
- Tim Administrasi Jasa 0.80% 1,189,550 1,189,550
Tambahan Penghasilan &
3 10% 15,860,669 15,860,669
Kesejahteraan Lainnya
JUMLAH 157,131,732 3,019,500 160,151,232
C. OPERASIONAL (DI LUAR JASA REMUNERASI) -
1 PMI - -
JUMLAH - - -
JUMLAH A + B+C 158,795,820 3,019,500 161,815,320

dr. ABDUL AZIZ, Sp. Rad

NIP. 19700403 200501 1 014
Mengetahui
Direktur RSUD dr. H. Moh. Anwar Pejabat Teknis Bendahara Pengeluaran
dr. ERLIYATI, M.Kes Dr. DIAN MARCIA, Sp.A I B N U, S. AN

NIP. 19700722 200012 2 003 NIP. 19660627 199703 2 001 NIP. 19840416 201001 1 008
Keterangan :
umum JUMLAH %
Pendapatan 486,434,059 486,434,059
1 Sarana 329,302,327 329,302,327 67.697%
2 Jasa Remunerasi 157,131,732 157,131,732 32.303%

3 Non Remunerasi (PMI) - - 0.000%
Total 157,131,732 157,131,732 100.0%
Hal ; 35
No Ruangan Gol Proporsional Kolektif Bruto Pajak Netto Tanda Tangan
1 Dr. ITJA FIRDARINI, SP.PK IV 1,028,649 145,871 1,174,520 176,178 998,342 1

2 Drg. Hj. RINTIH AZIS IV - - - - - 2
3 Dr. H. MOH. MUJIB, Sp.D IV 181,298 145,871 327,169 49,075 278,093 3
4 Dr. H. KARNEDI HOMBER, Sp.M IV 109,361 145,871 255,232 38,285 216,947 4
5 Dr. WINARHADI, SP.S III 377,669 143,615 521,284 26,064 495,220 5
6 Dr. DIAN MARCIA, Sp.A IV 1,629,531 - 1,629,531 244,430 1,385,101 6
7 Dr. DYAH PERTAMA S, Sp.THT III 1,345,427 143,615 1,489,042 74,452 1,414,590 7
8 Dr. Hj. SUHARTINAH IV - - - - - 8
9 Dr. Hj. AMITA SAFITRI IV 244,080 141,709 385,789 57,868 327,920 9
10 Dr. IMELDA KRISNASARI III - - - - - 10
11 Dr. SITI FATIMAH III - - - - - 11
12 Dr. TAURUS LAISARI III - - - - - 12
13 Dr. LAILA, Sp.Rad IV 1,979,204 141,359 2,120,563 318,084 1,802,479 13
14 Dr. DIDIK PERMADI, Sp.KFR III 240,563 141,359 381,922 19,096 362,826 14
15 Dr. DINA ISTIYANA RIDWAN III 59,400 145,521 204,921 10,246 194,675 15
16 Dr. SUSANTI RUSMALA DEWI, III - - - - - 16
17 Dr. ISNINA CHOLIFIAH WIDY III 3,091,538 145,521 3,237,059 161,853 3,075,206 17
18 Dr. RAHADIAN AYU NUR F III 269,978 145,521 415,499 20,775 394,724 18
19 LIZA WULNDARI,S.Farm, Apt III 110,380 128,872 239,253 11,963 227,290 19
20 MEGAWATI, Apt BLUD 88,640 114,304 202,944 202,944 20
21 SUHARTIK,Apt III 86,456 124,710 211,166 10,558 200,607 21
22 Dr. RENI IRVIANA EKA TANTRI, III 824,040 137,197 961,237 48,062 913,175 22
23 Dr. ALI RAHMAN, Sp.OG IV 216,765 166,682 383,447 57,517 325,930 23
24 Dr. CHUSNUL GHAIB, Sp.B III 191,550 162,170 353,720 53,058 300,662 24
25 Dr. RAHMI UTAMI, Sp.OG III 658,875 162,170 821,045 41,052 779,993 25
26 Dr. ABDUL AZIZ, Sp.Rad IV 1,979,204 139,103 2,118,307 317,746 1,800,561 26
27 Drg. HENNI KUSUMAWATI IV - 126,616 126,616 18,992 107,624 27
28 Dr. ANITAWATI IV 161,255 139,103 300,358 45,054 255,304 28
29 Dr. H. A. RIZKA RAHADI IV - - - - - 29
30 Dr. UTOMO, SpKJ IV 434,208 139,103 573,311 85,997 487,314 30
31 Dr. ENDAH, Sp.PD III 578,288 134,941 713,228 35,661 677,567 31
32 Dr. WONGSO,SpOG III 3,053,901 155,752 3,209,653 160,483 3,049,170 32
33 Dr. DOMINICUS H, SpA IKS - 103,724 103,724 2,593 101,131 33
34 Dr. ARYA RESI P, SpB III 3,353,581 159,914 3,513,495 175,675 3,337,820 34
35 Dr. FAZARRAHMAH, Sp.M III 109,361 122,454 231,815 11,591 220,224 35
36 Dr. NOVIA INDRIANI ADISTY, S III 201,143 126,616 327,759 16,388 311,371 36
37 Dr. RA. NIKMATILLAH RISKINA BLUD 188,978 132,860 321,838 8,046 313,792 37
38 Dr. AMIR FAISAL, Sp.JP TAMU - 51,862 51,862 1,297 50,565 38
39 LINA HERAWATI, S.Farm.,Apt. BLUD 92,351 112,048 204,399 204,399 39
40 LIZIYYANNIDA, S.Farm.,Apt. BLUD - - - - 40
41 SOFIA UNSIYAH, S.Farm.,Apt. BLUD 69,491 112,048 181,539 181,539 41
42 Dr. FARDIAN YEDAKUSUMA, S III 124,361 122,454 246,815 12,341 234,474 42
43 Dr. SYAIFUL KAMIL, M.Kes. Sp.BLUD 3,869,766 147,427 4,017,193 100,430 3,916,763 43
44 Dr. ANDRI DWI WAHYUDI, Sp.P III 900,966 139,103 1,040,069 52,003 988,065 44
45 drg. EKHTIYANTO CAHYADI KY III - 122,454 122,454 6,123 116,331 45
46 FAUZAN ARROZI, S.Farm.,Apt. III 73,406 122,454 195,860 9,793 186,067 46
47 ISTI ANAH, S.Farm.,Apt. III 75,853 122,454 198,306 9,915 188,391 47
48 Dr. MUH. KRIESTIAN, Sp.PD III 250,143 134,941 385,084 19,254 365,830 48
49 Dr. DWI ARYANINGRUM, Sp.KK III 23,389 40,818 64,207 3,210 60,996 49
50 Dr. ROSSY MEILANI, Sp..PK III 685,766 122,454 808,220 40,411 767,809 50
51 Dr. AULIA VILAYATI BLUD 224,978 132,860 357,838 8,946 348,892 51
52 dr. ABDUL MUNSY, Sp.An, M.Ked
WKDS 277,101 - 277,101 6,928 270,174 52
53 dr. TATAG NURHIDAYAT, Sp.AWKDS - - - - - 53
54 dr. DESWI ASTUTI, Sp.PA TAMU - - - - - 54
Hal ; 36
55 Dr. BATHRIQEL FAUZYANASWBLUD 242,978 130,604 373,582 9,340 364,242 55

56 Dr. IVA JAYA MARIA BLUD 188,978 130,604 319,582 7,990 311,592 56
57 Dr. FARAH DIANA AGUSTINA BLUD 188,978 130,604 319,582 7,990 311,592 57
58 Dr. VIVI KOERNIA WATY SUTRBLUD 218,678 130,604 349,282 8,732 340,550 58
59 Dr. NOOR AREZA ADHI PRATABLUD 188,978 130,604 319,582 7,990 311,592 59
60 dr. RUDI ISKANDAR S, Sp.An III 2,568,859 155,577 2,724,436 136,222 2,588,214 60
33,058,344 - -
OK BEDAH - -
61 MASDURA YUHEDI III 392,850 116,212 509,062 25,453 483,609 61
62 R. FATHORRAHMAN III 413,599 117,629 531,228 26,561 504,666 62
63 ABDULLAH MUCHLIS III 392,850 116,212 509,062 25,453 483,609 63
64 RAHMAD HENDRAWAN, Amd.K III 392,850 114,676 507,526 25,376 482,150 64
65 RAMLAN SUDMA HASTRAYUDAIII 392,850 114,557 507,407 25,370 482,037 65
OK OBGYN - - -
65 H.BACHTIAR EFFENDI Amd.Kep III 180,086 116,212 296,298 14,815 281,483 65
66 SRI SUHARTINGSIH III 180,086 117,748 297,834 14,892 282,943 66
67 IMAM SASMITO ,Amd.Kep III 180,086 113,140 293,226 14,661 278,565 67
68 RB. ABD. HAMID ,Amd.Kep III 162,078 114,676 276,753 13,838 262,916 68
ANASTESI - - -
68 WEDI III 277,514 113,140 390,654 19,533 371,121 68
69 SUGIANTO III 250,811 117,748 368,559 18,428 350,131 69
70 MUGIAMAN EH III 250,811 116,212 367,023 18,351 348,672 70
71 YUSUF RIZAL HADY, A.Md III 250,811 114,676 365,487 18,274 347,213 71
72 ERIC ANDRIAN, S.Kep.NS III 225,730 114,676 340,406 17,020 323,385 72
73 HIDAYAT HARIYANTO ,Amd.Ke III 225,730 113,140 338,870 16,943 321,926 73
74 MOH. ALIYANTO,Amd.Kep III 225,730 110,067 335,797 16,790 319,007 74
75 HIDAYAT RAHMAN, Amd.Kep III 225,730 113,140 338,870 16,943 321,926 75
- - -
ICU - - -
76 ALI ACHMAD, Amd.Kep III 57,924 114,557 172,481 8,624 163,857 76
77 ABU SOFYAN, Amd.Kep III 47,994 104,637 152,631 7,632 145,000 77
78 THAHIRATUL MUNAWARAH, AmIII 47,580 106,173 153,754 7,688 146,066 78
79 JONI SUPRIADIE, Amd.Kep III 47,994 103,220 151,214 7,561 143,654 79
80 MURNIASIH, Amd.Kep III 47,580 103,220 150,801 7,540 143,261 80
81 HENDRA SURIYAWAN, S.Kep.N III 51,304 109,008 160,312 8,016 152,296 81
82 SUTRISNO, S.Kep.NS III 51,304 107,710 159,014 7,951 151,063 82
83 SU'UDIYAH, S.Kep.NS III 47,994 107,710 155,704 7,785 147,919 83
84 NURUL FITRIYANTO, Amd.Kep III 47,580 103,220 150,801 7,540 143,261 84
85 NURUL HIDAYATI, Amd.Kep III 47,580 103,220 150,801 7,540 143,261 85
86 ANDI HERMAN WAHYUDI, Amd. III 47,580 103,220 150,801 7,540 143,261 86
87 DEDDY PURWANTO, Amd.Kep III 21,488 103,220 124,708 6,235 118,473 87
88 DEDY EKAFANTRI, S.Kep.Ns III 47,994 103,101 151,095 7,555 143,541 88
89 HAIRATUTTAQIYAH, Amd.Kep BLUD 35,685 88,811 124,497 124,497 89
- - -
NICU - - -
90 SRI ASTUTIK, S.Kep.NS IV 93,274 124,834 218,107 32,716 185,391 90
91 AWALAH, Amd.Kep III 128,377 107,710 236,087 11,804 224,282 91
92 TITIK SURATIH, Amd.Kep III 60,151 103,220 163,371 8,169 155,203 92
93 EMI SUFIANTI, Amd.Kep III 16,584 107,471 124,055 6,203 117,853 93
94 MYDIYANA DAFRIYANTI, Amd. III - - - - - 94
95 EVA SUSANTI WIDYANTINA, A III 66,584 109,008 175,591 8,780 166,812 95
96 NUNUK RAHMAWATI, Amd.Kep III 60,151 103,220 163,371 8,169 155,203 96
97 ERNAWATI, Amd.Kep III 66,584 109,008 175,591 8,780 166,812 97
98 AISYAH ULFA, Amd.Kep II 114,380 101,684 216,064 216,064 98
99 SRI WIDYAWATI, Amd.Kep III 60,151 106,054 166,206 8,310 157,895 99
100 SITI AMATILAH, Amd.Kep III 66,584 107,471 174,055 8,703 165,353 100
101 TITIN RANI ASTUTIK, Amd.Kep III 58,211 107,590 165,801 8,290 157,511 101
Hal ; 37
102 RICA RACHMAWATI, Amd.Kep III 60,151 106,054 166,206 8,310 157,895 102
103 DWI HENNY PRASETYARINI, AmIII 66,584 109,008 175,591 8,780 166,812 103
104 RATNA WAHYUNI, Amd.Kep III 52,390 103,220 155,610 7,780 147,829 104
105 SRI SURYATNI, Amd.Kep III 66,584 107,471 174,055 8,703 165,353 105
106 UTAMI KURNIAWATI, Amd.Kep III 66,584 107,471 174,055 8,703 165,353 106
107 ISNAWATII, AMd. Kep III 60,151 103,220 163,371 8,169 155,203 107
108 HIDAYATUL FITRIYAH, Amd.Ke
BLUD 37,792 88,811 126,603 126,603 108
109 ANIYAH, A.Md.Kep BLUD 50,389 88,811 139,201 139,201 109
110 SITI MUAWANAH, Amd.Kep BLUD 37,792 88,811 126,603 126,603 110
111 ARIFATUL KHAIR, Amd.Kep III 50,389 103,220 153,609 7,680 145,929 111
112 NURUL FADLILAH, A.Md.Keb BLUD 37,792 88,811 126,603 126,603 112
- - -
IRD - - -
113 NURUL SYAMSI, S.Kep.Ns III 210,819 117,629 328,448 16,422 312,025 113
114 ABD. RACHMAN CANDRA ,Amd. III 191,488 107,710 299,197 14,960 284,238 114
115 SUHARIONO BASUKI ,Amd.Kep III 191,488 106,173 297,661 14,883 282,778 115
116 RB ACH TAUFIK ,Amd.Kep III 179,548 103,220 282,768 14,138 268,630 116
117 AINUR FARID ,Amd.Kep III 191,488 106,173 297,661 14,883 282,778 117
118 FAIZAL RIZA ,Amd.Kep III 191,488 107,710 299,197 14,960 284,238 118
119 WEGI APRILIANSYAH ,Amd.Kep III 179,548 104,756 284,305 14,215 270,089 119
120 ANNIKA PARISTIAWATI, AMd. III 179,548 103,220 282,768 14,138 268,630 120
121 IKE YULIANTI, S.Kep.Ns BLUD 140,716 90,347 231,064 231,064 121
122 JUNAIDI, Amd.Kep III 191,488 104,637 296,125 14,806 281,319 122
123 AHMAD KURNIAWAN, Amd.Kep III 191,488 104,637 296,125 14,806 281,319 123
124 ACH. SUFANDI, AMd.Kep III 179,548 104,756 284,305 14,215 270,089 124
125 FAISOL ULUM, S.Kep.NS III 179,548 104,756 284,305 14,215 270,089 125
126 ACHMAD TAUFIKUL IKSAN, A.BLUD 140,716 88,811 229,528 229,528 126
127 RETNO AFRIADI, A.Md.Kep BLUD 140,716 88,811 229,528 229,528 127
128 DEKI ARIYANTO, S.Kep.Ns BLUD 140,716 90,347 231,064 231,064 128
129 ZAINAH AMd.Kep II 170,565 100,148 270,713 270,713 129
130 KHAIRATUL IMAMAH, A.Md.KeBLUD 140,716 88,811 229,528 229,528 130
131 NY. SITI ALPIYAH, Amd. Keb III 179,548 100,148 279,696 13,985 265,711 131
132 NY. HENNY RAHMAWATI S, Am III 179,548 100,148 279,696 13,985 265,711 132
IRD (118) - - -
133 REZA ZAINURI ALIM, S.Kep.NsBLUD 63,549 90,347 153,897 153,897 133
134 HENDRI GUNAWAN, A.Md.Kep BLUD 140,716 88,811 229,528 229,528 134
- - -
VK - - -
135 Hj. RUKAYYAH, AMd. Keb III 164,740 113,021 277,761 13,888 263,873 135
136 Hj. AINIYAH ULFAS, SST III 157,804 104,756 262,560 13,128 249,432 136
137 SRI WAHYUNI II 140,897 104,756 245,653 245,653 137
138 FENTY ZAKIYA, AMd. Keb II 140,897 101,684 242,581 242,581 138
139 KARSINI, AMd. Keb III 148,483 103,220 251,703 12,585 239,118 139
140 YULIYATIN, AMd. Keb III 148,483 103,220 251,703 12,585 239,118 140
141 SUCI WULANDARI, AMd.Keb III 44,692 100,148 144,840 7,242 137,598 141
142 ERMA DWI RISKIHATI, AMd.Ke III - - - - - 142
143 SUSILOWATI,S.ST III 148,483 101,684 250,167 12,508 237,659 143
144 HAERANI, AMd.Keb III 107,516 100,148 207,664 10,383 197,280 144
145 YULI ASTUTIK, AMd.Keb III 107,516 100,148 207,664 10,383 197,280 145
146 FARIHA, A.Md.Keb BLUD 75,869 88,811 164,680 164,680 146
147 INES FERANITA SISTOURINI, ABLUD 75,869 88,811 164,680 164,680 147
148 NOFITA ANGGRAINI, A.Md.KebBLUD 75,869 88,811 164,680 164,680 148
149 DYANATUR RASYIDAH, A.Md.K BLUD 75,869 88,811 164,680 164,680 149
150 FARIDAH, A.Md.Keb BLUD 75,869 88,811 164,680 164,680 150
151 FIFIN SUNDARI, A.Md.Keb BLUD 75,869 88,811 164,680 164,680 151
152 MISYUNI, A.Md.Keb BLUD - - - - 152
153 MULYA YULI RAHAYU, A.Md.KBLUD 75,869 88,811 164,680 164,680 153
Hal ; 38
154 SARWENDAH KUSUMA W, A.Md BLUD 75,869 88,811 164,680 164,680 154
155 NUR SOFI RUSYANTI A, A.Md.KBLUD 27,312 88,811 116,123 116,123 155
156 RIAS ADRI PRAJAYANTI, Amd. III 107,516 100,148 207,664 10,383 197,280 156
157 IRMA SUSANTI, Amd. Keb II 25,905 100,148 126,053 126,053 157
- - -
RUANG BEDAH - - -
158 MOH. KAMIM, S.Kep.NS III 307,930 119,165 427,095 21,355 405,740 158
159 WIWIN APRIYANTI, Amd.Kep III 277,137 104,637 381,774 19,089 362,685 159
160 IRWIN DAHLIARSIH, Amd.Kep III 270,157 103,220 373,377 18,669 354,709 160
161 DINCE DAMAYANTI, Amd.Kep III 375,157 104,756 479,914 23,996 455,918 161
162 HERLINA NINGSIH, Amd.Kep III 270,157 104,756 374,914 18,746 356,168 162
163 IRWAN SUGIANTO, Amd.Kep III 270,157 103,220 373,377 18,669 354,709 163
164 SITI NURHAYATI, Amd.Kep III 270,157 107,710 377,867 18,893 358,973 164
165 IMA KHOSAIMA, Amd.Kep III 270,157 103,220 373,377 18,669 354,709 165
166 EMMY DWI SETIAWATI, Amd.K III 270,157 103,220 373,377 18,669 354,709 166
167 JONI SUHARTONO, Amd.Kep III 270,157 104,756 374,914 18,746 356,168 167
168 UMAR SAID, S.Kep.Ners III 270,157 100,148 370,305 18,515 351,790 168
169 SUCI AINI GALUH A, Amd.Kep III 270,157 103,220 373,377 18,669 354,709 169
- - -
RUANG ANAK - - -
170 YULIASTRI, Amd.Kep III 368,493 116,093 484,586 24,229 460,357 170
171 FREDDY SEPTA WASUDY, Amd III - - - - - 171
172 IRYANTI ISTIQOMAH, Amd.Kep II 321,548 104,756 426,305 426,305 172
173 JONI HARIYANTO, S.Kep.Nes III 342,749 106,173 448,923 22,446 426,477 173
174 HENDRI FEBRIYANTO, Amd.Kep III 319,024 103,220 422,245 21,112 401,132 174
175 SUMIYATI, Amd.Kep III 319,024 104,756 423,781 21,189 402,592 175
176 EKO PRASETYO A, S.Kep.NS BLUD 704,444 90,347 794,791 794,791 176
177 SITI AISYAH, A.Md.Kep III 319,024 100,148 419,172 20,959 398,214 177
- - -
RUANG INTERNA - - -
178 ERMAWATI, S.Kep.NS III 98,974 117,629 216,603 10,830 205,773 178
179 IZZUL HILAL ,Amd.Kep III 81,065 106,173 187,238 9,362 177,876 179
180 KUSTIANINGSIH, Amd.Kep III 73,524 103,220 176,744 8,837 167,907 180
181 SITI SUBAIDAH, AMd.Kep III 73,524 103,220 176,744 8,837 167,907 181
182 SRI DIANA INDRA DEWI, Amd.K III 73,524 103,220 176,744 8,837 167,907 182
183 NANI KARTIKA, AMd. Kep II 73,524 98,969 172,493 172,493 183
184 SOFIA LOREN BLUD 73,524 90,347 163,871 163,871 184
185 NUR HASANAH, AMd.Kep III 73,524 104,756 178,280 8,914 169,366 185
186 HENNY LISTIANINGSIH, AMd.K III 279,427 106,292 385,720 19,286 366,434 186
187 AIDA KUSUMA DEWI, Amd.Kep III 281,544 104,756 386,301 19,315 366,986 187
188 SRI SUHERLINA, Amd.Kep III 73,524 103,220 176,744 8,837 167,907 188
189 SUGIYANTO, Amd.Kep III 59,293 103,220 162,514 8,126 154,388 189
190 DAUD SULAIMAN, Amd.Kep III 61,665 100,148 161,813 8,091 153,722 190
191 SRI MULYANI, Amd.Kep III - - - - - 191
- - -
RUANG DAHLIA - - -
192 MUNAWAR, S.Kep.NS III 233,844 116,093 349,937 17,497 332,440 192
193 YULI HERLINA NINGSIH, Amd.K III 215,623 103,220 318,843 15,942 302,901 193
194 MARIA ULFA, Amd.Kep III 223,519 103,220 326,739 16,337 310,402 194
195 SUSANTO WAHYUDI, Amd.Kep III 223,519 103,220 326,739 16,337 310,402 195
196 HAMDANI PRAYETNO, Amd.Kep III 223,519 104,756 328,275 16,414 311,861 196
197 IKE DINA NOVIATIN, Amd.Kep III 223,519 103,220 326,739 16,337 310,402 197
198 SEMI FUJI, Amd.Kep III 194,364 103,220 297,584 14,879 282,705 198
199 RA.SITI ROHANI II 223,519 104,756 328,275 328,275 199
200 ROBIHAH, Amd.Kep III 223,519 103,220 326,739 16,337 310,402 200
201 SRI RAHAYU NINGSIH, Amd.Ke III 223,519 103,220 326,739 16,337 310,402 201
202 BUSTOMI ARIFIN, Amd.Kep III 223,519 103,220 326,739 16,337 310,402 202
Hal ; 39
203 AMIR HASAN ,Amd.Kep III 109,330 103,220 212,550 10,627 201,922 203
204 RASUL HIDAYAT III 223,519 103,220 326,739 16,337 310,402 204
205 RONI AGUS WINDRIYANTO, A.M
BLUD 200,438 88,811 289,249 289,249 205
206 SEPTARINA PARAMITHA, S.Kep.
BLUD - - - - 206
207 ISTIQOMATUS SHALIHAH, A.Md
BLUD - - - - 207
- - -
GRIU - - -
208 SIGIT SETIAWAN, S.Kep.Ns III 550,244 124,595 674,839 33,742 641,097 208
209 AZIZAH, AMd.Kep II 436,958 107,471 544,430 544,430 209
210 CICI ROSIDAH, AMd.Kep III 425,954 106,054 532,008 26,600 505,408 210
211 ENY YUNIARSIH, S.Kep.Ns III 436,958 109,008 545,966 27,298 518,668 211
212 RB. ACH. HIDAYAT, AMd.Kep III 425,954 106,054 532,008 26,600 505,408 212
213 Hj. HOLISATUL JANNAH, AMd.K III 425,954 106,054 532,008 26,600 505,408 213
214 YULIA AFIDATUL, AMd.Kep III 425,954 106,054 532,008 26,600 505,408 214
215 IMAM WAHYUDI, AMd.Kep III 425,954 106,054 532,008 26,600 505,408 215
216 DEWI YULISTIKA, AMd.Kep III 425,954 107,471 533,425 26,671 506,754 216
217 Hj. ISTRI II 422,863 107,590 530,454 530,454 217
218 SITI JAMILAH, AMd.Kep III 425,954 106,054 532,008 26,600 505,408 218
219 LINDA RUSTIANI, AMd.Kep III 425,954 106,054 532,008 26,600 505,408 219
220 QURRATUL AINI, AMd.Kep III 425,954 106,054 532,008 26,600 505,408 220
221 RAFIKA KURNIA, AMd.Kep III 425,954 - 425,954 21,298 404,656 221
222 FITRIA, S.Kep.Ns III 436,958 109,008 545,966 27,298 518,668 222
223 SRI MULYANI, AMd.Kep III 436,958 109,008 545,966 27,298 518,668 223
224 SRI PUJI ASTUTIK, AMd.Kep III 425,954 106,054 532,008 26,600 505,408 224
225 SUSIYATI, S.Kep.Ns III 436,958 109,008 545,966 27,298 518,668 225
226 WEMIKA DEWI, AMd.Kep III 436,958 107,471 544,430 27,221 517,208 226
227 JENNI CHANDRA, AMd.Kep III 436,958 109,008 545,966 27,298 518,668 227
228 YUM'AINI, AMd.Kep III 422,863 107,471 530,334 26,517 503,818 228
229 FRIESTY DYAN, Amd.Kep III 436,958 102,982 539,940 26,997 512,943 229
230 BAHTIAR YULIANSYAH ,Amd.K III 412,213 107,590 519,804 25,990 493,813 230
231 HARMINI, A.Md.Kep III - 102,982 102,982 5,149 97,833 231
232 ISTIQOMATUS SHALIHAH, A.Md BLUD 364,132 91,645 455,777 455,777 232
233 DENI PEBRIANTO, S.Kep.Ns BLUD 364,132 93,182 457,314 457,314 233
234 YAYUK IKA FARIDAWATI, A.Md BLUD 364,132 91,645 455,777 455,777 234
235 MUHAMMAD WILDAN FARID, B ALUD 352,386 91,645 444,031 444,031 235
236 EKRAL RAMADHONA, S.Kep.NsBLUD 364,132 93,182 457,314 457,314 236
237 YENI AGUSTINA, A.Md.Kep BLUD 317,147 91,645 408,793 408,793 237
238 DWI SOFIRA II 404,591 106,054 510,646 510,646 238
239 UMMI SUSTIANA, Amd.Kep III 425,954 106,054 532,008 26,600 505,408 239
240 SEPTIADI TRI FERDIAN, S.Kep.N
BLUD 364,132 93,182 457,314 457,314 240
241 SEPTARINA PARAMITA A, S.Kep BLUD 364,132 93,182 457,314 457,314 241
242 HIDAYATUR RAHMAN, Amd.Ke III 425,954 102,982 528,936 26,447 502,489 242
243 NUKE WAHYUNINGTYAS, Amd. II 391,540 102,982 494,522 494,522 243
244 MARIYATUL KIPTIYAH III 425,954 109,127 535,080 26,754 508,326 244
245 DIAH INDRIYANI, Amd.Kep III 425,954 102,982 528,936 26,447 502,489 245
- - -
LABORAT - - -
208 NURUL HERLINA III - - - - - 208
209 ALFI NURUL MARHAMAH III 576,215 116,093 692,308 34,615 657,692 209
210 YAYUS SUGIARTI NINGSIH, A. III 329,266 103,220 432,486 21,624 410,861 210
211 DEWI RATIH WIDIYANTI, A.Md III 329,266 103,220 432,486 21,624 410,861 211
212 WARISA NOVITA SARI, A.Md, A III 329,266 101,684 430,950 21,547 409,402 212
213 ANIS HALIMIYAH, A.Md III 329,266 101,684 430,950 21,547 409,402 213
214 NURUL FITRIYAH, Amd III 329,266 103,220 432,486 21,624 410,861 214
215 DEBRINA KARTIKA SARI, A.Md III 329,266 101,684 430,950 21,547 409,402 215
216 HENDRI BUDIONO BLUD 312,802 91,884 404,686 404,686 216
217 JAMILA,Amd.AK BLUD 296,339 88,811 385,150 385,150 217
218 LISA MEILANA,Amd.AK BLUD 296,339 88,811 385,150 385,150 218
- - -
Hal ; 40
POLI INTERNA - - -
219 SUMARTINI III 118,919 111,961 230,880 11,544 219,336 219
220 JAMI'AH III 76,448 102,041 178,489 8,924 169,565 220
- - -
POLI GIGI - - -
221 PRITTA SAHADATINA, A.Md.KesIII 121,618 108,888 230,506 11,525 218,981 221
222 RUSTAM III 121,618 95,897 217,515 10,876 206,639 222
223 SHAFRIN HAMIDAH, A.Md.Kes.GIII 27,028 94,360 121,388 6,069 115,319 223
- - - -
POLI KUK - - - -
224 RIRIN SATARIYAH IV 154,524 119,165 273,689 41,053 232,636 224
- - -
POLI MATA - - -
225 MUH. NUR HIDAYAT BUDI S IV 93,738 114,795 208,533 31,280 177,253 225
226 ADET MARIYANTO,S.Kep III 72,908 103,339 176,247 8,812 167,434 226
227 MERI HADIYATI III 80,856 102,041 182,897 9,145 173,753 227
- - -
POLI KANDUNGAN - - -
228 TAJUN NISAK III 147,609 113,497 261,106 13,055 248,050 228
229 NURHAYATI, AMd. Keb II 83,718 101,803 185,522 185,522 229
230 MARIA ULFA II - - - - 230
- - -
HD - - -
231 M A F R U D A H, A.Md,Kep III - 111,961 111,961 5,598 106,363 231
232 ZAID MAHMUD, A.Md,Kep III - 102,041 102,041 5,102 96,939 232
233 SUBAIDAH III - 102,041 102,041 5,102 96,939 233
234 R.M. DJAUHARI, A.Md,Kep III - 100,505 100,505 5,025 95,480 234
235 QURAISYIN, Amd.Kep III - 98,969 98,969 4,948 94,020 235
236 ABD. HAMID, AMd.Kep III - - - - - 236
237 RAFIATUL ADAWIYAH, Amd.Ke III 60,151 97,433 157,584 7,879 149,705 237
- - -
POLI SYARAF - - -
238 SUMIYATI III 164,419 114,795 279,214 13,961 265,253 238
239 M U N I R A III 102,762 101,803 204,565 10,228 194,337 239
- - -
POLI ANAK - - -
240 ENDANG TEGOWATI, Amd. Kep III 56,822 111,961 168,783 8,439 160,344 240
- - -
POLI THT - - -
241 CICIK ERNANINGSIH III 493,323 111,961 605,284 30,264 575,020 241
242 Hj. INDAYANI, AMd.Kep III 403,628 102,041 505,669 25,283 480,386 242
- - -
POLI BEDAH - - -
243 LISTRIYANINGSIH III 232,535 111,961 344,496 17,225 327,271 243
244 SITI MAISARAH III 161,255 104,875 266,131 13,307 252,824 244
245 SONY LAKSONO II 43,706 103,339 147,045 147,045 245
- - -
RADIOLOGI - - -
246 ENDANG ASTIKOWATI, A.Md III 685,212 113,140 798,352 39,918 758,434 246
247 ATIEK NOORMASARI, A.Md III 600,988 101,684 702,672 35,134 667,538 247
248 HIDAYATUR R, AMd. Rad III 600,988 100,148 701,136 35,057 666,079 248
249 NOVI NUR HAYATI, AMd. Rad III 600,988 100,148 701,136 35,057 666,079 249
250 EKA SRI WAHYUNI, AMR BLUD 450,741 88,811 539,552 539,552 250
- - -
REHAB MEDIK - - -
251 NANANG HERU SUMARSONO IV 228,683 113,497 342,180 51,327 290,853 251
252 SITI RAHMANIYAH, A.Md III 166,315 97,433 263,748 13,187 250,560 252
Hal ; 41
253 ASRIYANAH, A.Md.Fis III 166,315 97,433 263,748 13,187 250,560 253
- - -
INSTALASI GIZI - - -
254 HAIRUNNISYAK III 32,868 120,463 153,331 7,667 145,664 254
255 NUR'AINI III 21,670 110,425 132,094 6,605 125,490 255
256 SALAMET HARIYADI III 28,482 117,510 145,992 7,300 138,692 256
257 MARZUKI III 21,063 111,961 133,024 6,651 126,373 257
258 LAILATUL ISRAWIYAH, AMd.G III 27,741 103,220 130,961 6,548 124,413 258
259 RATRI PURWANI, SST III 30,825 111,723 142,548 7,127 135,421 259
260 RINA WASESA APRILIANA, S.GBLUD 27,134 90,347 117,482 117,482 260
261 NOERYDA PRAMUDYA, S.Gz BLUD 27,134 90,347 117,482 117,482 261
262 SUSANTIN FAJARIYAH, AMd.Gz III 22,678 85,977 108,655 5,433 103,222 262
263 ERMA ASTUTI III 22,678 84,441 107,119 5,356 101,763 263
- - -
APOTIK - - -
264 SRI HIDAYATI, A.Md.AF III 74,167 107,471 181,638 9,082 172,556 264
265 NOVI HERIYATIE III 67,044 104,399 171,443 8,572 162,871 265
266 NUR HAYATI II 59,839 104,399 164,238 164,238 266
267 ASTY REDIANA III 62,199 105,935 168,134 8,407 159,728 267
268 ELLY SILFIANI III 62,199 104,399 166,598 8,330 158,268 268
269 LILIK NOR AFIAH II 55,462 104,399 159,861 159,861 269
270 YETTI FIRANDANI III 65,402 104,399 169,801 8,490 161,311 270
271 ARIESTA AINUR GAFUR III 58,154 101,327 159,480 7,974 151,506 271
272 IKA YUNI SUSILOWTI, A.Md.AF III 67,762 104,399 172,161 8,608 163,553 272
273 ELVI RIRIN A, A.Md.AF III 67,762 104,399 172,161 8,608 163,553 273
274 NURY SOVYARINA BLUD 50,231 85,739 135,970 135,970 274
275 ABDIR RASYID AL HABIBI BLUD 50,231 85,739 135,970 135,970 275
276 IKA AGUSTINE BLUD 52,591 88,811 141,402 141,402 276
277 ERYKA DAMAYANTI BLUD 50,231 85,739 135,970 135,970 277
278 AHMAD ANSORI BLUD 50,231 85,739 135,970 135,970 278
279 TUTIK ALWIYAH, Amd.Farm. BLUD 52,591 88,811 141,402 141,402 279
280 GITA METASARI, Amd.Farm. BLUD 37,323 59,208 96,530 96,530 280
- - -
SANITASI - - -
281 WARTATIK WARDANINGSIH, AmIII - 106,054 106,054 5,303 100,752 281
282 ERLIN SUPRAPTI, Amd. KL III - 104,637 104,637 5,232 99,405 282
283 SUMARSIH, Amd. KL III - 101,684 101,684 5,084 96,600 283
- - -
CSSD - - -
284 MOH. RUSLAN ,Amd.Kep II - 104,756 104,756 104,756 284
-
POLI VCT - - -
285 RAFIDATUL RISKIYAH III 155,739 103,220 258,959 12,948 246,011 285
- - -
POLI JIWA - - -
286 NUR HIDAYAT III 235,243 103,458 338,701 16,935 321,766 286
287 BAMBANG RUDIYANTO II 116,598 93,301 209,899 209,899 287
- - -
POLI JANTUNG - - -
288 ENDANG WULANDARI, A.Md.Ke III 100,977 97,314 198,291 9,915 188,377 288
- - -
POLI PARU -
289 IKE WULANDARI, Amd.Kep III 123,552 113,140 236,692 11,835 224,857 289
290 ERLYN WAHYUNI III 123,552 101,684 225,236 11,262 213,974 290
-
POLI KULIT & KELAMIN - - -
Hal ; 42
291 NURUL IZZATI, Amd. Kep III 149,688 111,961 261,649 13,082 248,566 291
- -
KEUANGAN - -
292 SURYO KUSUMO III 90,701 90,701 4,535 86,166 292
293 MOH. ANSORULLAH III 91,069 91,069 4,553 86,516 293
294 IBNU III 93,077 93,077 4,654 88,423 294
295 FERI SUDARWADI III 94,357 94,357 4,718 89,639 295
296 YANUAR PUTRA BLUD 71,065 71,065 71,065 296
297 JOHNI ERIYANTO III 93,169 93,169 4,658 88,510 297
298 ACH. BUHARI III 90,885 90,885 4,544 86,341 298
299 AINUR SUBHAN II 32,994 86,132 119,126 119,126 299
300 AGUS YANTO II 86,132 86,132 86,132 300
301 MOHAMMAD TAYYIB III 90,885 90,885 4,544 86,341 301
302 JAKA ARDINATA RAHMAN, SE.BLUD 69,877 69,877 69,877 302
303 SYAIFUL MAKRUF III 92,073 92,073 4,604 87,469 303
304 MOH. ROBBI ARONI, SH BLUD 69,877 69,877 69,877 304
- - -
PERENCANAAN & PROGRAM - - -
305 DHODY ROFSANJANI SKM III 85,405 85,405 4,270 81,135 305
306 SURYANI RAHMANINGSIH, S.KBLUD 69,877 69,877 69,877 306
307 NOVITA TRI SUPRIYANTI, S.KM
BLUD 69,877 69,877 69,877 307
- - -
PELAYANAN - - -
308 AYU SITO RESMI II 79,556 79,556 79,556 308
309 ACH. REZA FACHRIZIE II 79,556 79,556 79,556 309
310 ENDANG SRI WAHYUNI III - - - - 310
- - -
SIM RS - - -
311 MOH. FERYADI ST III 90,977 90,977 4,549 86,428 311
312 EDI WIDIYANTO II 79,556 79,556 79,556 312
313 MOH. FIRMAN ARIF, S.Kom BLUD 69,877 69,877 69,877 313
314 IRMA OCTARINA, A.Md BLUD 68,689 68,689 68,689 314
315 NILA AYU SULISTIAWATI, A.MBLUD 68,689 68,689 68,689 315
- - -
INEV - - -
316 SINTA APRILIA LUSIANTI III 84,309 84,309 4,215 80,093 316
- - -
PENUNJANG - - -
317 DEWI SUSYLOWATI III 84,309 84,309 4,215 80,093 317
318 FERIYANTO III 80,745 80,745 4,037 76,707 318
- - -
SDM - - -
319 SUHARTONO MAHMUD II 85,497 85,497 85,497 319
320 MUHARTO II 79,556 79,556 79,556 320
321 RA. DINA NOVIANA III - - - - 321
322 FATHORRAHMAN II 84,309 84,309 84,309 322
323 RIZAL KHAIRIL SALAM II 86,501 86,501 86,501 323
324 MUSAHWI II 79,556 79,556 79,556 324
325 ERRY SRI WIDAJATI III 4,500 83,121 87,621 4,381 83,240 325
326 MOH. FADLI BLUD 65,124 65,124 65,124 326
327 MOCH. NUR JULIANTO, S.Kom BLUD 69,877 69,877 69,877 327
- - -
INSTALASI GIZI - - -
328 HANIYAH II 9,704 81,933 91,637 91,637 328
329 ARFANIYAH II 9,704 81,933 91,637 91,637 329
330 INDARYATI II 9,704 81,933 91,637 91,637 330
331 YULISTIANA II 9,704 76,361 86,065 86,065 331
Hal ; 43
332 NINGRIANI II 9,704 75,172 84,877 84,877 332

333 WIDIANING ASTUTIK II 8,087 68,597 76,683 76,683 333
334 FRIDA NIRWANINGSIH IKS 9,704 69,692 79,397 79,397 334
- - -
ADM GABUNGAN POLI - - -
335 Drs. ABD. LATIF III - - - - 335
336 FANDI II 76,268 76,268 76,268 336
337 SUJONO II 75,080 75,080 75,080 337
338 SURAIDA BLUD 65,124 65,124 65,124 338
- - -
MEDICAL RECORD - - -
339 ABDUL FARID, A.Md,PK III 83,029 83,029 4,151 78,877 339
340 DEVI MERYL III 80,745 80,745 4,037 76,707 340
341 DESY PURNAMA PRATIWI, A.MBLUD 68,689 68,689 68,689 341
342 AMALIA HIDAYATI, A.Md,RMIBLUD 68,689 68,689 68,689 342
343 LUTFIE, A.Md.RMIK BLUD 68,689 68,689 68,689 343
- - -
FILLING SYSTEM - - -
344 MOH. AMIN II 79,556 79,556 79,556 344
345 SAMSUNI II 80,652 80,652 80,652 345
346 AGUS HIDAYAT II 72,980 72,980 72,980 346
- - -
IPP - - -
347 VINDA SARTIKA BASRI, S.KM III 86,501 86,501 4,325 82,176 347
348 HERMAN WAHYUDI, S.I.Kom BLUD 69,877 69,877 69,877 348
349 R MASNGABAI NURMUHAMMA III 83,029 83,029 4,151 78,877 349
- - -
FRONT OFFICE - - -
350 HENDRIK III 89,789 89,789 4,489 85,299 350
351 BAGUS BUDI DARMO, SH III 84,309 84,309 4,215 80,093 351
352 SLAMET MULYADI II 79,556 79,556 79,556 352
353 KAMARUDIN, SE III 85,497 85,497 4,275 81,222 353
354 YUDIONO II 79,556 79,556 79,556 354
355 AKHMAD FAUZI III 86,593 86,593 4,330 82,263 355
356 DONI WIJAYANTO III 79,556 79,556 3,978 75,579 356
357 SURYADI II - - - 357
358 FIKAYATUS SHALIHAH BLUD 65,124 65,124 65,124 358
359 RINI PURWATI BLUD 65,124 65,124 65,124 359
360 ROBIATUL AULIYAH BLUD 65,124 65,124 65,124 360
361 TIZAN RAMDANI PUTRA BLUD 65,124 65,124 65,124 361
362 RASIDI III 85,497 85,497 4,275 81,222 362
363 WAWAN BLUD 66,312 66,312 66,312 363
- - -
LOGISTIK - - -
364 MUHAMMAD ZAINUDIN III 86,501 86,501 4,325 82,176 364
365 YULIASTIN SE III 78,921 78,921 3,946 74,975 365
366 SUTRISNO III 81,656 81,656 4,083 77,574 366
- - -
IPS - - -
367 HERMANTO,SST III 87,413 87,413 4,371 83,042 367
368 R.B. AINOR RACHMAN II - - - 368
369 ANITA HARIANI,AMD.Tek.Med III 83,029 83,029 4,151 78,877 369
370 HARTONO EKO PRASETIO, A.M III 79,925 79,925 3,996 75,929 370
371 MUH. ALI III 81,841 81,841 4,092 77,749 371
372 ACHMAD NUR FAUZI BLUD 66,312 66,312 66,312 372
373 ASMUNI II 75,357 75,357 75,357 373
- - -
Hal ; 44
SANITASI - - -
374 FATHORRAHMAN II - 68,597 68,597 68,597 374
- - -
CSSD - -
375 SUCIPTO II - 77,457 77,457 77,457 375
376 BUDIYANTO II - 76,268 76,268 76,268 376
377 SUKIRNO II 75,357 75,357 75,357 377
378 RB. ABD. RAHMAN II 75,357 75,357 75,357 378
- -
LAUNDRY - - -
379 MISNAWI II 75,357 75,357 75,357 379
380 ABUYASID II 72,980 72,980 72,980 380
381 AGUS RIADI II 74,169 74,169 74,169 381
382 KARTINA II - - - 382
- - -
KAMAR JENAZAH - - -
383 SAMSUL ARIFIN III 75,443 79,741 155,183 7,759 147,424 383
384 AFI SAPUTRA II - 72,980 72,980 72,980 384
385 AGUS DARMAWAN BLUD 65,124 65,124 65,124 385
386 MUSAHERI BLUD 65,124 65,124 65,124 386
387 NORITA HENDRO IRAWAN BLUD 66,312 66,312 66,312 387
- - -
388
ADMINISTRASI & CLEANING SERVICE - - - 388
389 WAHYUDI KAMIL (ADM OK) II 65,358 79,556 144,914 144,914 389
390 SUHERMANTO (HELPER) II 109,621 81,933 191,553 191,553 390
391 EDY SUCIPTO (CS OK) II 109,621 79,556 189,177 189,177 391
392 ABDURRAHMAN (CS OK) II 109,621 79,556 189,177 189,177 392
- - -
393 ASRIYANTO (ADM RADIOLOGI) III 299,780 77,733 377,513 18,876 358,638 393
- - -
394 NOVITA RAHAYU (ADM LAB) III 177,639 77,733 255,372 12,769 242,603 394
395 MOH. SALEH (CS LAB) II 197,559 81,933 279,492 279,492 395
- - -
396 NURHADI (CS HD) II - 72,980 72,980 72,980 396
- - -
397 SLAMET HARYONO (ADM R. IC II 24,825 82,209 107,034 107,034 397
398 SUJARWO (CS ICU) II 8,689 72,980 81,669 81,669 398
- - -
399 DEWI SUPRIYATIN (ADM R. NI III 30,076 77,733 107,809 5,390 102,418 399
- - -
400 SUDARTO (ADM Z. INTERNE) II 152,703 72,980 225,684 225,684 400
401 R. MOH. FAJAR ALAMSYAH II 285,472 72,980 358,453 358,453 401
- - -
402 MAYA FAIRUSTIN (ADM Z. AN III 196,614 77,733 274,347 13,717 260,629 402
- - -
403 FATHORRAHMAN (ADM Z. BED III 226,842 77,733 304,575 15,229 289,346 403
- - -
404 DWI MEGA WIDYANINGSIH (AD II 73,701 79,556 153,258 153,258 404
405 MOH. ISMAIL (HELPER) II 16,690 75,172 91,863 91,863 405
- - -
406 RATNA DEWI AGUSTIN (ADM I II 195,939 85,497 281,436 281,436 406
407 FAUZA BLUD 46,621 65,124 111,745 111,745 407
408 ABD. RASID (CS IRD) II 93,811 80,745 174,555 174,555 408
409 MOH TOHED (CS IRD) II 93,811 80,745 174,555 174,555 409
410 HERMANTO (CS IRD) II 93,811 79,556 173,367 173,367 410
411 MISRAWI (CS IRD) II 93,811 80,745 174,555 174,555 411
412 JUMADIN (CS IRD) II 93,811 79,556 173,367 173,367 412
Hal ; 45
- - -
AMBULANCE - - -
413 ADNAN II 84,125 84,125 84,125 413
414 MOHAMMAD AMIN II 81,933 81,933 81,933 414
415 DASRO PRIYANTO II 80,745 80,745 80,745 415
416 SUKARDI II 80,745 80,745 80,745 416
417 JUMA'IDIN II 75,357 75,357 75,357 417
418 SASMITO III 85,497 85,497 4,275 81,222 418
419 ROBIYANTO II 80,745 80,745 80,745 419
420 ZAIFUL RAHMADI BLUD 72,888 72,888 72,888 420
421 ATMAWI II - - - 421
422 JOKO BUDIARSO BLUD 71,700 71,700 71,700 422
423 MUHAMMAD WILDAN SHALEH
BLUD 65,124 65,124 65,124 423
424 AKHMAD HENDRO IRAWAN BLUD 72,888 72,888 72,888 424
425 RUSLAN AINUR ROSIDI BLUD 71,700 71,700 71,700 425
426 NAUFAL NAWARI BLUD 72,796 72,796 72,796 426
427 CHOLIQ MARYONO BLUD 71,700 71,700 71,700 427
428 SAMSURIADI BLUD 72,888 72,888 72,888 428
- - -
APOTIK - - -
429 NINA FIRDA YULIANTI, S.KM BLUD 45,512 - 45,512 45,512 429
430 R. IMAM RAMLI II - - - - 430
431 EKO WARDOYO III 22,837 81,933 104,770 5,238 99,531 431
432 KADIMAN (CS FARMASI) BLUD 28,655 66,312 94,968 94,968 432
- - -
SECURITY - - -
433 MOHAMMAD MUSTAFA BLUD 65,124 65,124 65,124 433
434 NOER SIDIK FEBRIYANTO BLUD 65,124 65,124 65,124 434
435 JUANDONO BLUD 65,124 65,124 65,124 435
436 FATHORRAHMAN BLUD 65,124 65,124 65,124 436
437 CHOLIF PURNOMO BLUD 65,124 65,124 65,124 437
438 FIRMAN BLUD 65,124 65,124 65,124 438
439 KADARISMAN BLUD 65,124 65,124 65,124 439
440 SISKA FEBRIYANZAH BLUD 65,124 65,124 65,124 440
441 ZAINUR RAHMAN BLUD 65,124 65,124 65,124 441
442 JONI ANDIKA BLUD 65,124 65,124 65,124 442
443 ACH. FIRMAN RAMADHAN BLUD 65,124 65,124 65,124 443
444 INSAN KAMIL BLUD 65,124 65,124 65,124 444
445 WAHYUDI ARDIANSYAH BLUD 65,124 65,124 65,124 445
446 ACH. FAHMIYAFI BLUD 65,124 65,124 65,124 446
447 ANDY SUTRISNO BLUD 65,124 65,124 65,124 447
448 MOH. SYAIFUL RAHMAN BLUD 65,124 65,124 65,124 448
449 ACHMAT SUKRON BLUD 65,124 65,124 65,124 449
450 ARIF IBNO FAJAR BLUD 65,124 65,124 65,124 450
451 MOH. IVAN RAMDHANI BLUD 65,124 65,124 65,124 451
452 SANTONO BLUD 65,124 65,124 65,124 452
453 ERWAN JULIO BLUD 65,124 65,124 65,124 453
454 SUTRISNO BLUD 65,124 65,124 65,124 454
455 IMAM ZAIROSI BLUD 65,124 65,124 65,124 455
456 LUTFI ARISANTO BLUD 65,124 65,124 65,124 456
- -
ADM GRIU - - -
457 ENDANG SUKARELAWATI III 247,453 81,933 329,386 16,469 312,917 457
458 ACH. JUNAIDI III 255,702 81,933 337,634 16,882 320,753 458
459 MISNAWI BLUD 80,918 65,124 146,043 146,043 459
- - -
86,930,314 45,133,429 132,063,743 6,131,019 125,932,724
45,133,429
Hal ; 46
-
dr. ABDUL AZIZ, Sp. Rad

NIP. 19700403 200501 1 014
Mengetahui
Direktur RSUD dr. H. Moh. Anwar Pejabat Teknis Bendahara Pengeluaran
dr. ERLIYATI, M.Kes Dr. DIAN MARCIA, Sp.A I B N U, S. AN

NIP. 19700722 200012 2 003 NIP. 19660627 199703 2 001 NIP. 19840416 201001 1 008
Hal ; 47
5% PAJAK
15% Prop Kolektf
- 154,297 21,881 - -
- - - - -
- 27,195 21,881 - -
- 16,404 21,881 - -
- 18,883 7,181 - -
- 244,430 - - -
- 67,271 7,181 - -
- - - - -
- 36,612 21,256 - -
- - - - -
- - - - -
- - - - -
- 296,881 21,204 - -
- 12,028 7,068 - -
- 2,970 7,276 - -
- - - - -
- 154,577 7,276 - -
- 13,499 7,276 - -
- 5,519 6,444 - -
- - -
- 4,323 6,235 - -
- 41,202 6,860 - -
- 32,515 25,002 - -
- 28,733 24,326 - -
- 32,944 8,109 - -
- 296,881 20,865 - -
- - 18,992 - -
- 24,188 20,865 - -
- - - - -
- 65,131 20,865 - -
- 28,914 6,747 - -
- 152,695 7,788 - -
- - 2,593 - -
- 167,679 7,996 - -
- 5,468 6,123 - -
- 10,057 6,331 - -
- 4,724 3,321 - -
- - 1,297 - -
- - -
- - -
- - -
- 6,218 6,123 - -
- 96,744 3,686 - -
- 45,048 6,955 - -
- - 6,123 - -
- 3,670 6,123 - -
- 3,793 6,123 - -
- 12,507 6,747 - -
- 1,169 2,041 - -
- 34,288 6,123 - -
- 5,624 3,321 - -
- 6,928 - - -
- - - - -
- - - - -
Hal ; 48
5% PAJAK
15% Prop Kolektf
- 6,074 3,265 - -
- 4,724 3,265 - -
- 4,724 3,265 - -
- 5,467 3,265 - -
- 4,724 3,265 - -
- 128,443 7,779 - - -
2,316,168 429,587 2,745,755 Pajak Medis 33,058,344
2,316,168 429,587 - - 273,193
- 19,643 5,811 - - 231,010
- 20,680 5,881 - - 378,971
- 19,643 5,811 - -
- 19,643 5,734 - -
- 19,643 5,728 - -
-
- 9,004 5,811 - -
- 9,004 5,887 - -
- 9,004 5,657 - -
- 8,104 5,734 - -
-
- 13,876 5,657 - -
- 12,541 5,887 - -
- 12,541 5,811 - -
- 12,541 5,734 - -
- 11,286 5,734 - -
- 11,286 5,657 - -
- 11,286 5,503 - -
- 11,286 5,657 - -
- -
- -
- 2,896 5,728 - - 30,595
- 2,400 5,232 - - 30,595
- 2,379 5,309 - -
- 2,400 5,161 -
- 2,379 5,161 - -
- 2,565 5,450 - -
- 2,565 5,385 - -
- 2,400 5,385 - -
- 2,379 5,161 - -
- 2,379 5,161 - -
- 2,379 5,161 -
- 1,074 5,161 - -
- 2,400 5,155 - -
- -
- -
- -
- 13,991 18,725 - - 64,302
- 6,419 5,385 - - 67,309
- 3,008 5,161 - -
- 829 5,374 - -
- - - - -
- 3,329 5,450 - -
- 3,008 5,161 - -
- 3,329 5,450 - -
-
- 3,008 5,303 - -
- 3,329 5,374 - -
- 2,911 5,380 - -
Hal ; 49
5% PAJAK
15% Prop Kolektf
- 3,008 5,303 - -
- 3,329 5,450 - -
- 2,619 5,161 - -
- 3,329 5,374 - -
- 3,329 5,374 - -
- 3,008 5,161 - -
-
- -
- -
- 2,519 5,161 - -
- -
- -
- -
- 10,541 5,881 - - 130,829
- 9,574 5,385 - - 130,829
- 9,574 5,309 - -
- 8,977 5,161 - -
- 9,574 5,309 - -
- 9,574 5,385 - -
- 8,977 5,238 - -
- 8,977 5,161 - -
- -
- 9,574 5,232 - -
- 9,574 5,232 - -
- 8,977 5,238 - -
- 8,977 5,238 - -
- -
-
-
-
- 8,977 5,007 - -
- 8,977 5,007 - -
- -
- -
- -
- -
- -
- 8,237 5,651 - - 56,762
- 7,890 5,238 - - 56,762
- -
- -
- 7,424 5,161 - -
- 7,424 5,161 - -
- 2,235 5,007 - -
- - - - -
- 7,424 5,084 - -
- 5,376 5,007 - -
- 5,376 5,007 - -
- -
- -
- -
- -
- -
-
-
-
Hal ; 50
5% PAJAK
15% Prop Kolektf
-
-
- 5,376 5,007 - -
-
- -
- -
- 15,396 5,958 - - 169,582
- 13,857 5,232 - - 479,948
- 13,508 5,161 -
- 18,758 5,238 - -
- 13,508 5,238 -
- 13,508 5,161 -
- 13,508 5,385 - - 409,675
- 13,508 5,161 - -
- 13,508 5,161 - -
- 13,508 5,238 - -
- 13,508 5,007 - -
- 13,508 5,161 - -
- -
- -
- 18,425 5,805 - - 83,416
- - - - - 110,279
- -
- 17,137 5,309 - -
- 15,951 5,161 -
- 15,951 5,238 -
-
- 15,951 5,007 - -
- -
- -
- 4,949 5,881 - - 106,305
- 4,053 5,309 - - 127,065
- 3,676 5,161 - -
- 3,676 5,161 -
- 3,676 5,161 - -
- -
- -
- 3,676 5,238 -
- 13,971 5,315 -
- 14,077 5,238 - -
- 3,676 5,161 - -
- 2,965 5,161 -
- 3,083 5,007 - -
- - - - -
- -
-
- 11,692 5,805 - - 127,065
- 10,781 5,161 -
- 11,176 5,161 - -
- 11,176 5,161 - -
- 11,176 5,238 - -
- 11,176 5,161 - -
- 9,718 5,161 - -
- -
- 11,176 5,161 - -
- 11,176 5,161 -
- 11,176 5,161 -
Hal ; 51
5% PAJAK
15% Prop Kolektf
- 5,466 5,161 - -
- 11,176 5,161 - -
-
-
-
- 541,667
- 27,512 6,230 - - 6,189,265
- (5,647,598)
- 21,298 5,303 - -
- 21,848 5,450 - -
- 21,298 5,303 - -
- 21,298 5,303 - -
- 21,298 5,303 - -
- 21,298 5,303 - -
- 21,298 5,374 - -
-
- 21,298 5,303 - -
- 21,298 5,303 - -
- 21,298 5,303 - -
- 21,298 - - -
- 21,848 5,450 - -
- 21,848 5,450 - -
- 21,298 5,303 - -
- 21,848 5,450 - -
- 21,848 5,374 - -
- 21,848 5,450 - -
- 21,143 5,374 - -
- 21,848 5,149 - -
- 20,611 5,380 - -
- - 5,149 - -
-
-
-
-
-
-
-
- 21,298 5,303 - -
-
-
- 21,298 5,149 - -
-
- 21,298 5,456 - -
- 21,298 5,149 - -
-
- -
- - - - - 127,590
- 28,811 5,805 - - 127,590
- 16,463 5,161 - -
- 16,463 5,161 - -
- 16,463 5,084 - -
- 16,463 5,084 - -
- 16,463 5,161 - -
- 16,463 5,084 - -
- -
-
-
- -
Hal ; 52
5% PAJAK
15% Prop Kolektf
- -
- 5,946 5,598 - - 9,768
- 3,822 5,102 - - 9,768
- -
- -
- 6,081 5,444 - - 12,162
- 6,081 4,795 - - 13,513
- 1,351 4,718 - -
- -
- -
- 23,179 17,875 - - 23,179
- - 19,820
- -
- 14,061 17,219 - - 21,749
- 3,645 5,167 - - 21,749
- 4,043 5,102 - -
- -
- -
- 7,380 5,675 - - 7,380
- - 7,380
- -
- -
- -
- - 5,598 - - -
- - 5,102 - - -
- - 5,102 - -
- - 5,025 - -
- - 4,948 -
- - - - -
- 3,008 4,872 - -
- -
- -
- 8,221 5,740 - - 13,359
- 5,138 5,090 - - 13,359
- -
- -
- 2,841 5,598 - - 2,841
- - 1,871
- -
- 24,666 5,598 - - 44,848
- 20,181 5,102 - - 44,848
- -
- -
- 11,627 5,598 - - 19,690
- 8,063 5,244 - - 19,690
- -
- -
- -
- 34,261 5,657 - - 124,409
- 30,049 5,084 - - 124,409
- 30,049 5,007 - -
- 30,049 5,007 - -
-
- -
- -
- 34,302 17,025 - - 50,934
- 8,316 4,872 - - 50,934
Hal ; 53
5% PAJAK
15% Prop Kolektf
- 8,316 4,872 - -
- -
- -
- 1,643 6,023 - - 10,400
- 1,083 5,521 - - 10,400
- 1,424 5,875 - -
- 1,053 5,598 - -
- 1,387 5,161 - -
- 1,541 5,586 - -
-
-
- 1,134 4,299 - -
1,134 4,222 - -
- -
- -
- 3,708 5,374 - - 26,234
- 3,352 5,220 - - 26,234
- -
- 3,110 5,297 - -
- 3,110 5,220 - -
- -
- 3,270 5,220 - -
- 2,908 5,066 - -
- 3,388 5,220 - -
- 3,388 5,220 - -
- -
- -
- -
- -
- -
-
-
- -
- -
- - 5,303 - - -
- - 5,232 - - -
- - 5,084 - -
- -
- -
- -
- 7,787 5,161 - - 7,787
- - 5,916
- -
- 11,762 5,173 - - 11,762
- - 11,762
- -
- -
- 5,049 4,866 - - 5,049
- - 5,049
- -
- 6,178 5,657 - - 12,355
- 6,178 5,084 - - 12,355
- -
- - 7,484
Hal ; 54
5% PAJAK
15% Prop Kolektf
- 7,484 5,598 - - 7,484
2,040,047 1,094,943 3,134,989 70,844 2,473,872
- 1,094,943 - 2,040,047 50,215,218
- - 4,535 - -
- - 4,553 - -
- - 4,654 - -
- - 4,718 - -
- -
- - 4,658 - -
- - 4,544 - -
- -
- -
- - 4,544 - -
- -
- - 4,604 - -
- -
- -
- -
- - 4,270 - -
- -
- -
- -
- -
- -
- -
- - - - - 7,380
- -
- -
- - 4,549 - -
- -
- -
- -
- -
- -
- -
- - 4,215 - -
- -
- -
- - 4,215 - -
- - 4,037 - -
- -
- -
- -
- -
- - - - -
- -
- -
- -
- 225 4,156 - -
- -
- -
- -
- -
- -
- -
- -
- -
Hal ; 55
5% PAJAK
15% Prop Kolektf
- -
- -
- -
- -
- -
- - - - -
- -
- -
- -
- -
- -
- - 4,151 - -
- - 4,037 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- - 4,325 - -
- -
- - 4,151 - -
- -
- -
- - 4,489 - -
- - 4,215 - -
- -
- - 4,275 - -
- -
- - 4,330 - -
- - 3,978 - -
- -
- -
- -
- -
- -
- - 4,275 - -
- -
- -
- -
- - 4,325 - -
- - 3,946 -
- - 4,083 - -
- -
- -
- - 4,371 - -
- -
- - 4,151 - -
- - 3,996 - -
- - 4,092 - -
- -
- -
- -
Hal ; 56
5% PAJAK
15% Prop Kolektf
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 3,772 3,987 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 14,989 3,887 - -
- -
- 8,882 3,887 - -
- -
- -
- -
- -
- -
- -
- -
- 1,504 3,887 - -
- -
- -
- -
- -
- 9,831 3,887 - -
- -
- 11,342 3,887 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
Hal ; 57
5% PAJAK
15% Prop Kolektf
- -
- -
- -
- -
- -
- -
- -
- - 4,275 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 1,142 4,097 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 12,373 4,097 - -
- 12,785 4,097 - -
76,844 173,430 250,275 3,072,679

173,430 6,131,019 86,346,241 TOTAL
- -
Hal ; 58
5% PAJAK
15% Prop Kolektf
4,433,059 1,697,960 6,131,019
Pajak Prop
(0)
RSUD Dr.H.MOH. ANWAR KAB. SUMENEP
MENEJEMEN
13,200,556
PAJAK
NO NA MA GOL. JABATAN BPJS I SPM JAMPERSAL BRUTO
5%
1 dr. Erliyati, M.Kes 4 Direktur 2,111,741 2,111,741

2 H. Asfan Effendi, SkepNs 4 Ka Bag TU 1,055,871 1,055,871
3 Dr. Dian Marcia, Sp.A 4 Ka Bid Pelayanan 1,055,871 1,055,871
4 Dr. Kusmuni 3 Ka Bid Penunjang 1,055,871 1,055,871 52,794
5 Dr. Suhartinah 4 Ka Bid Inev 1,055,871 1,055,871
6 Syaful Anwar, SE 3 Ka Sub. Bag. Keuangan 659,919 659,919 32,996
7 Lalu Saprul Fajri, SKM 3 Ka Sub. Bag. Program & Perenc 659,919 659,919 32,996
8 Hendiyanto, SE 3 Ka Sub. Bag. Umum &Kepegawai 659,919 659,919 32,996
9 Unik W 3 Ka Sie Rawat Inap 659,919 659,919 32,996
10 Hmam Muslim, S.Kep.NS 4 Plt. Ka Sie Rawat Jalan 164,980 164,980
11 H. Hermanto, S.Kep.NS 3 Ka Sie Peneunjang Medis 659,919 659,919 32,996
12 Soepardi, ST 3 Ka Sie Peneunjang Non Medis 659,919 659,919 32,996
13 H. Arman Endika P, SKM.MKes 4 Ka Sie Informasi 659,919 659,919
14 Hmam Muslim, S.Kep.NS 4 Ka Sie Evaluasi 494,939 494,939
JUMLAH 11,614,576 - - 11,614,576 250,769
1,240
Mengetahui
Direktur RSUD dr. H. Moh. Anwar Tim Pembagi Jasa

NIP. 19700722 200012 2 003 NIP. 19700403 200501 1 014
FTAR PENERIMA JASA MEDIS BPJS I, SPM & JAMPERSAL
RSUD Dr.H.MOH. ANWAR KAB. SUMENEP
PAJAK
NETTO TANDA TANGAN
15%
316,761 1,794,980 1
158,381 897,490
158,381 897,490 3
1,003,077 4
158,381 897,490
626,923 6
626,923
626,923 8
626,923 9
24,747 140,233 10
626,923
626,923 12
98,988 560,931 13
74,241 420,698 14
989,879 10,373,928
1,240,648
I B N U, S. AN
NIP. 19840416 201001 1 008
TAHUN 2020
OKTOB
∑ Hari
ER
index
Tidak PROP
GOL
No
NAMA Masuk
Indeks % 5,540,666
31
1 SIGIT SETIAWAN, S.Kep.Ns III 3.400 3.4000 3.26% 180,472
KAS (Hj. ISTRI) III 4.000 4.0000 3.83% 212,319
2 TRI HARYONO ADI, AMd.Kep III 0.0000 0.00% -
3 ADET MARYANTO, S.Kep.Ns III
4 AZIZAH, AMd.Kep III 2.700 2.7000 2.59% 143,316
5 CICI ROSIDAH, AMd.Kep III 2.632 2.6320 2.52% 139,706
6 ENY YUNIARSIH, S.Kep.Ns III 2.700 2.7000 2.59% 143,316
7 RB. ACH. HIDAYAT, AMd.Kep III 2.632 2.6320 2.52% 139,706
8 Hj. HOLISATUL JANNAH, AMd.Kep III 2.632 2.6320 2.52% 139,706
9 YULIA AFIDATUL, AMd.Kep III 2.632 2.6320 2.52% 139,706
10 IMAM WAHYUDI, AMd.Kep III 2.632 2.6320 2.52% 139,706
11 DEWI YULISTIKA, AMd.Kep III 2.632 2.6320 2.52% 139,706
12 Hj. ISTRI III 2.700 1 2.6129 2.50% 138,693
13 SITI JAMILAH, AMd.Kep III 2.632 2.6320 2.52% 139,706
14 LINDA RUSTIANI, AMd.Kep III 2.632 2.6320 2.52% 139,706
15 ENDANG TEGOWATI III 0.000 0.0000 0.00% -
16 QURRATUL AINI, AMd.Kep III 2.632 2.6320 2.52% 139,706
17 RAFIKA KURNIA, AMd.Kep III 2.632 2.6320 2.52% 139,706
18 FITRIA, S.Kep.Ns III 2.700 2.7000 2.59% 143,316
19 SRI MULYANI, AMd.Kep III 2.700 2.7000 2.59% 143,316
20 SRI PUJI ASTUTIK, AMd.Kep III 2.632 2.6320 2.52% 139,706
21 SUSIYATI, S.Kep.Ns III 2.700 2.7000 2.59% 143,316
22 WEMIKA DEWI, AMd.Kep III 2.700 2.7000 2.59% 143,316
23 JENNI CHANDRA, AMd.Kep III 2.700 2.7000 2.59% 143,316
24 YUM'AINI, AMd.Kep III 2.700 1 2.6129 2.50% 138,693
25 ZAINAH AMd.Kep II 0.0000 0.00% -
26 NURUL SYAMSI, S.Kep.Ns III
27 FRIESTY DYAN, Amd.Kep III 2.700 2.7000 2.59% 143,316
28 BAHTIAR YULIANSYAH ,Amd.Kep III 2.632 1 2.5471 2.44% 135,200
29 HARMINI, A.Md.Kep III 2.632 31 0.0000 0.00% -
30 RONI AGUS WINDRIYANTO, A.Md.Ke BLUD 0.0000 0.00%
31 ISTIQOMATUS SHALIHAH, A.Md.Kep BLUD 2.25 2.2500 2.16% 119,430
32 DENI PEBRIANTO, S.Kep.Ns BLUD 2.25 2.2500 2.16% 119,430
33 YAYUK IKA FARIDAWATI, A.Md.Kep BLUD 2.25 2.2500 2.16% 119,430
34 MUHAMMAD WILDAN FARID, A.Md.K BLUD 2.25 1 2.1774 2.09% 115,577
35 EKRAL RAMADHONA, S.Kep.Ns BLUD 2.25 2.2500 2.16% 119,430
36 YENI AGUSTINA, A.Md.Kep BLUD 2.25 4 1.9597 1.88% 104,019
37 DWI SOFIRA II 2.5 2.5000 2.40% 132,700
38 UMMI SUSTIANA, Amd.Kep III 2.632 2.6320 2.52% 139,706
39 SEPTIADI TRI FERDIAN, S.Kep.Ns BLUD 2.25 2.2500 2.16% 119,430
40 SEPTARINA PARAMITA A, S.Kep.Ns BLUD 2.25 2.2500 2.16% 119,430
41 HIDAYATUR RAHMAN, Amd.Kep III 2.632 2.6320 2.52% 139,706
42 NUKE WAHYUNINGTYAS, Amd.Kep II 2.500 1 2.4194 2.32% 128,419
43 MARIYATUL KIPTIYAH III 2.632 2.6320 2.52% 139,706
44 DIAH INDRIYANI, Amd.Kep III 2.632 2.6320 2.52% 139,706
45 TITIN RANI ASTUTIK, Amd.Kep III 2.632 31 0.0000 0.00% -
45 ENDANG SUKARELAWATI III 1.85 1 1.7903 1.72% 95,030
46 ACH. JUNAIDI III 1.58 1.5800 1.51% 83,866
47 AINUR SUBHAN II 1.58 27 0.2039 0.20% 10,821
48 ABD. RAHMAN II 0.0000 0.00% -
49 SUKIRNO II 0.5 0.5000 0.48% 26,540
50 MISNAWI BLUD 0.5 0.5000 0.48% 26,540
51 HERMANTO, SST III 0.5 0.5000 0.48% 26,540
52 WARTATIK WARDANINGSIH (IPAL) III 0.5 0.5000 0.48% 26,540
111.79 99 104.384 100.00% 5,540,666
NUKE WAHYUNINGTYAS, Amd.Kep c 2.000 BERLAKU SEPT-OKT

2.500 BERLAKU MULAI NOPEMBER
KOLEKT ADM TOTAL NETTO PEBR
2,308,611 1,154,565 9,003,841 CUTI
28
75,196 37,607 293,275 14,664 278,611 INDEKS DARI JULI-SEPT'19, DIGES
88,466 44,243 345,029 17,251 327,778
- - - - - 1
59,715 29,864 232,895 11,645 221,250

58,211 29,112 227,029 11,351 215,678
59,715 29,864 232,895 11,645 221,250
58,211 29,112 227,029 11,351 215,678 2
58,211 29,112 227,029 11,351 215,678
58,211 29,112 227,029 11,351 215,678
58,211 29,112 227,029 11,351 215,678
58,211 29,112 227,029 11,351 215,678 1
57,789 28,901 225,382 11,269 214,113
58,211 29,112 227,029 11,351 215,678 1
58,211 29,112 227,029 11,351 215,678 31 28
- - - - - 1
58,211 29,112 227,029 11,351 215,678
58,211 29,112 227,029 11,351 215,678 18
59,715 29,864 232,895 11,645 221,250 1
59,715 29,864 232,895 11,645 221,250
58,211 29,112 227,029 11,351 215,678
59,715 29,864 232,895 11,645 221,250 1 2
59,715 29,864 232,895 11,645 221,250
59,715 29,864 232,895 11,645 221,250
57,789 28,901 225,382 11,269 214,113
- - - -
- - - 1
59,715 29,864 232,895 11,645 221,250
56,333 28,173 219,706 10,985 208,720 1
- - - -
- - 1 1
49,762 24,887 194,079 194,079
49,762 24,887 194,079 194,079
49,762 24,887 194,079 194,079
48,157 24,084 187,818 187,818 1
49,762 24,887 194,079 194,079
43,341 21,676 169,036 169,036
55,292 27,652 215,643 215,643 3
58,211 29,112 227,029 11,351 215,678
49,762 24,887 194,079 194,079
49,762 24,887 194,079 194,079
58,211 29,112 227,029 11,351 215,678 1
53,508 26,760 208,687 208,687
58,211 29,112 227,029 11,351 215,678
58,211 29,112 227,029 11,351 215,678
- - - - -
39,596 19,802 154,428 7,721 146,707 1 1
34,944 17,476 136,287 6,814 129,472 2 1
4,509 2,255 17,585 17,585
UNTUK BPJS MEI 2019 (INDEKS DI REVIEW)
- - - -
11,058 5,530 43,129 43,129 1
11,058 5,530 43,129 43,129
11,058 5,530 43,129 2,156 40,972
11,058 5,530 43,129 2,156 40,972
2,308,611 1,154,565 9,003,841 347,717 8,656,124 64 38
INDEKS FERI BPJS KEMBALI DIHITUNG 2 HARI

INDEKS FERI UMUM KEMBALI DIHITUNG 4 HARI
MART APRL MEI
31 30 31
DARI JULI-SEPT'19, DIGESER KE ENY
1
1
1 2
1 2
1 2
3 1
2
2 2
1 2
1
1
1 1
1
1 3 3
DEKS DI REVIEW)
2 1
1
13 16 13
Visite Dr. ARYA
84,150 85%
RESI P, SpB
4,208 5%
79,943
PROPORSIONAL MEDIS
RUANG
NO NA MA GOL. FARMASI RUANG RAWAT JALAN
IRD ANAK KANDGN INTERNE BEDAH GIGI MATA HD THT SYARAF VCT JIWA JANTUNG PARU KULIT LAB RONTG KUK REHMED OK SENTR OK IRD ANAST ICU
1 Dr. ITJA FIRDARINI, SP.PK 4 1,028,649
2 Drg. Hj. RINTIH AZIS 4 - -
3 Dr. H. MOH. MUJIB, Sp.D 4 90,000 76,448 - - -
4 Dr. H. KARNEDI HOMBER, 4 - 109,361 -
5 Dr. WINARHADI, SP.S 3 75,000 246,629 10,500 21,780
6 Dr. DIAN MARCIA, Sp.A 4 105,000 -
7 Dr. DYAH PERTAMA S, Sp. 3 1,345,427 -
8 Dr. Hj. SUHARTINAH 4 - - - - -
9 Dr. Hj. AMITA SAFITRI 4 - - 30,888 62,186 151,006
10 Dr. IMELDA KRISNASARI 3 - - - -
11 Dr. SITI FATIMAH 3 - - - -
12 Dr. TAURUS LAISARI 3 - - - - -
13 Dr. LAILA, Sp.Rad 4 1,979,204
14 Dr. DIDIK PERMADI 3 - - - 240,563 -
15 Dr. DINA ISTIYANA RIDW 3 - -
16 Dr. SUSANTI RUSMALA DEW 3 - - - - - -
17 Dr. ISNINA CHOLIFIAH W 3 3,091,538 - -
18 Dr. RAHADIAN AYU NUR F 3 188,978 - - -
19 LIZA WULNDARI,S.Farm, A 3 110,380
20 MEGAWATI, Apt BLUD 88,640
21 Dr. RENI IRVIANA EKA TAN 3 135,000 190,080 -
22 SUHARTIK,Apt 3 86,456
23 Dr. ALI RAHMAN, Sp.OG 4 120,000 69,765 - - - -
24 Dr. CHUSNUL GHAIB, Sp.B 4 45,000 116,550 - - - -
25 Dr. RAHMI UTAMI, Sp.OG 3 187,550 69,765 - - -
26 Dr. ABD. AZIS, Sp.Rad 4 1,979,204
27 Drg. HENNI KUSUMAWATI 4 - -
28 Dr. ANITAWATI 4 - - 161,255 - - -
29 Dr. H. A. RIZKA RAHADI 4 - - -
30 Dr. UTOMO SpKJ 4 30,000 - 404,208 -
31 Dr. ENDAH, Sp.PD 3 90,000 76,448 94,050
32 Dr. WONGSO,SpOG 3 185,000 69,765 2,256,875 - -
33 Dr. DOMINICUS H, SpA IKS -
34 Dr. ARYA RESI P, SpB III 335,746 117,549 2,900,286 - -
35 Dr. FAZARRAHMAH, Sp.M III - 109,361
36 Dr. NOVIA INDRIANI ADIST III - 201,143 -
37 Dr. RA. NIKMATILLAH RI BLUD 188,978 -
38 Dr. AMIR FAISAL, Sp.JP TAMU - - -
39 LINA HERAWATI, S.Farm.,A BLUD 92,351
40 LIZIYYANNIDA, S.Farm.,Apt BLUD -
41 SOFIA UNSIYAH, S.Farm.,Ap BLUD 69,491
42 Dr. FARDIAN YEDAKUSUMA III 15,000 109,361
43 Dr. SYAIFUL KAMIL, M.Kes. BLUD 117,549 3,647,217
44 Dr. ANDRI DWI WAHYUDI, III 165,000 180,576 -
45 drg. EKHTIYANTO CAHYAD III -
46 FAUZAN ARROZI, S.Farm.,A III 73,406
47 ISTI ANAH, S.Farm.,Apt. III 75,853
48 Dr. MUH. KRIESTIAN, Sp.P III 76,448 72,270
49 Dr. DWI ARYANINGRUM, S III 23,389
50 Dr. ROSSY MEILANI, Sp..P III 685,766
51 Dr. AULIA FILAYATI BLUD 188,978 -
52 dr. ABDUL MUNSY, Sp.An, MWKDS - 277,101 -
53 dr. TATAG NURHIDAYAT, S WKDS
54 dr. DESWI ASTUTI, Sp.PA
55 Dr. BATHRIQEL FAUZYA BLUD 188,978 -
56 Dr. IVA JAYA MARIA BLUD 188,978
57 Dr. FARAH DIANA AGUSTI BLUD 188,978 -
58 Dr. VIVI KOERNIA WATY BLUD 188,978 29,700
59 Dr. NOOR AREZA ADHI P BLUD 188,978 - -
60 dr. RUDI ISKANDAR S, Sp.A III - 2,418,589 72,270
596,576 6,181,659 - 209,296 229,343 512,903 - 328,084 - 1,345,427 246,629 30,888 466,394 - 370,656 224,532 1,714,415 3,958,408 161,506 240,563 8,804,378 - 2,695,690 290,070
447,317 6,181,659 3,742 209,296 229,343 512,903 - 328,084 - 1,345,427 246,629 30,888 466,394 - 370,656 201,143 1,714,415 3,958,408 10,500 240,563 5,241,406 - 2,695,690 290,070
149,258 - (3,742) - - - - - - - - - - - - - 151,006 - 3,562,972 - - -
Konsul taktis 3,647,217
927,550
MEDIS BPJS I, SPM & JAMPERSAL
OKTOBER 2020
ANWAR KAB. SUMENEP
RUANG
RUANG RAWAT INAP BRUTO PAJAK NETTO
PICU ANAK BEDAH INTERNE DAHLIA GRIU KANDGN
1,028,649 154,297 874,352 154,297
- - - -
- 14,850 - - 181,298 27,195 154,103 13,500
- - - - - - 109,361 16,404 92,957
- - - 23,760 - - 377,669 18,883 358,785
575,586 948,945 - - 1,629,531 244,430 1,385,101
- - - - - 1,345,427 67,271 1,278,156
- - - - -
- - 244,080 36,612 207,468
- - - - - - -
- - - - - - - -
- - - - - - - -
1,979,204 296,881 1,682,324
- - - 240,563 12,028 228,535
29,700 29,700 - - - - 59,400 2,970 56,430
- - - - - - - -
- - - - 3,091,538 154,577 2,936,961
- 81,000 - - 269,978 13,499 256,479
- 110,380 5,519 104,861
88,640 88,640
- 95,040 403,920 - 824,040 41,202 782,838
86,456 4,323 82,133
- 27,000 216,765 32,515 184,251
- - 30,000 - - - 191,550 28,733 162,818
- - - 401,560 658,875 32,944 625,932
- 1,979,204 296,881 1,682,324
- - -
- - - 161,255 24,188 137,067
- - -
- - - - 434,208 65,131 369,077
- 109,890 207,900 - 578,288 28,914 549,373
- 89,100 453,160 3,053,901 152,695 2,901,206
- - - -
- - - - - 3,353,581 167,679 3,185,902
- - 109,361 5,468 103,893
- - - 201,143 10,057 191,086
- - - 188,978 4,724 184,254
- - -
- 92,351 92,351
- -
69,491 69,491
- - 124,361 6,218 118,143
105,000 - - 3,869,766 96,744 3,773,022
- 555,390 - 900,966 45,048 855,918
- - - - -
73,406 3,670 69,735
75,853 3,793 72,060
101,426 - - 250,143 12,507 237,636
- 23,389 1,169 22,219
685,766 34,288 651,478
- - 36,000 - - 224,978 5,624 219,354
- - - - 277,101 6,928 270,174
- - - -
- - -
- 54,000 - - 242,978 6,074 236,904
188,978 4,724 184,254
- - - - 188,978 4,724 184,254
- - - 218,678 5,467 213,211
- - - 188,978 4,724 184,254
78,000 2,568,859 128,443 2,440,416
605,286 978,645 384,000 344,966 1,256,310 - 881,720 33,058,344 2,316,168 30,742,176
605,286 978,645 384,000 344,966 1,256,310 - 881,720 33,058,344 2,316,168 30,742,176
- - - - - - - 2,042,976
273,193
OK SENTRAL OK SENTRAL
EMERGENCY ELEKTIF PEMBULATAN EMERGENCY ELEKTIF
(100%) (60%)
KECIL 2,175,120 1,900,080 KECIL 2,175,120 1,900,080 KECIL
SEDANG 2,725,100 2,375,100 SEDANG 2,725,100 2,375,100 SEDANG
BESAR 3,674,940 3,200,000 BESAR 3,674,940 3,200,000 BESAR
KHUSUS 4,425,120 3,850,080 KHUSUS 4,425,120 3,850,080 KHUSUS
100% KLIM
60% JASPEL OK BEDAH % RIIL

OK BEDAH 12,226,896 USNUL GHAIB, Sp.B - 0.00%
OK ORTOPEDI - . ARYA RESI P, SpB 2,931,907 100.00%
OK OBGYN 4,371,840 2,931,907 100.00%
TOTAL 16,598,736 OK OBGYN Dr. CHUSNUL GHAIB, Sp.B
Dr. ALI RACHMAN, Sp.OG - 0.00% Dr. ARYA RESI P, SpB
Dr. RAHMI UTAMI, Sp.OG - 0.00% Dr. ALI RACHMAN, Sp.OG
Dr. WONGSO, Sp.OG 2,361,516 100.00% Dr. RAHMI UTAMI, Sp.OG
Dr. CHUSNUL GHAIB, Sp.B - 0.00% Dr. WONGSO, Sp.OG
2,361,516 100.00%
Pendamping Dr. Ali -
Pendamping Dr. Rahmi -
Pendamping Dr. Wongso 84,245
DAFTAR PENERIMA JASA MEDIS BPJS I, SPM

Dr. CHUSNUL GHAIB Dr. ARYA Dr. KAMIL
K EMERGENCY - - 1 223,950
SE - - -
BE - - -
KHE - - -
K ELEKTIF - - -
S - - -
B - - -
KH - - -
Total - - - - 1 223,950
Medis - - 100,778
Anastesi - - 123,173
Klaim 100% Penurunan dari Data Perda JP

113,191,763 OK Bedah 3860.7% 67,164,583
107,475,629 OK Obsgyn 4551.1% 63,306,961
Data Zal Bedah MEDIS

- Dr. Ghaib Dr. CHUSNUL GHAIB, Sp.B -
2,931,907 Dr. Arya Dr. ARYA RESI P, SpB -
2,931,907 Dr. SYAIFUL KAMIL, M.Kes. Sp.B -
dr. RINANTI S, Sp.An -
Data Zal Kaber Dr. ACENG APANDI, Sp.An -
- Dr. Ali Dr. ALI RACHMAN, Sp.OG -
- Dr. Rahmi Dr. RAHMI UTAMI, Sp.OG -
2,361,516 Dr. Wongso Dr. WONGSO, Sp.OG -
2,361,516
DAFTAR PENERIMA JASA MEDIS NON GR

Dr. CHUSNUL GHAIB, Sp.B Dr. ARYA RESI P, SpB Dr. SYAIFUL KAMIL, M.Kes. Sp.B
K EMERGENCY - - -
SE - - -
BE - - -
KHE - - -
K ELEKTIF - - -
S - - -
B - - -
KH - - -
Total - - - - - -
Medis - - -
Anastesi - - -
DAFTAR PENERIMA JASA MEDIS GRIU

Dr. CHUSNUL GHAIB, Sp.B Dr. ARYA RESI P, SpB Dr. SYAIFUL KAMIL, M.Kes. Sp.B
K EMERGENCY - - -
SE - - -
BE - - -
KHE - - -
K ELEKTIF - - -
S - - -
B - - -
KH - - -
Total - - - - - -
Medis - - -
Anastesi - - -
EMERGENCY ELEKTIF DENGAN Dr. ANASTESI NON Dr. ANASTESI
1,305,072 1,140,048 Medis 53.55% Medis 53.55%

61.27%
1,635,060 1,425,060 Dr.Anastesi 17.16% 7.72%
2,204,964 1,920,000 Asisten 16.07% Asisten 16.07% 16.07%
2,655,072 2,310,048 Asisten Anas 10.73% Asisten Anas 10.73%
20.16%
Admin+CS 2.50% 9.44%
100.00% Admin+CS 2.50% 2.50%
100.00% 100.00%
BULAN : OKTOBER 2020 (Dr. ACENG APANDI, Sp.An)

UMUM BPJS SPM TOTAL Dr. CHUSNUL GHAIB, Sp.B
ZAL ZAL GRIU ZAL Dr. ARYA RESI P, SpB
Dr. CHUSNUL GHAIB, Sp.B 0 Dr. SYAIFUL KAMIL, M.Kes. Sp.B
Dr. ARYA RESI P, SpB 0 dr. RINANTI S, Sp.An
Dr. ALI RACHMAN, Sp.OG 0 Dr. ACENG APANDI, Sp.An
Dr. RAHMI UTAMI, Sp.OG 0 Dr. ALI RACHMAN, Sp.OG
Dr. WONGSO, Sp.OG 0 Dr. RAHMI UTAMI, Sp.OG
TOTAL 0 0 0 0 0 Dr. WONGSO, Sp.OG
ASISTEN ANASTESI
JASA MEDIS BPJS I, SPM & JAMPERSAL ACC

Dr. ALI RAHMAN Dr. RAHMI UTAMI Dr. WONGSO
- - -
- - -
- 1 378,372 -
- - -
- - -
- - -
- - -
- - -
- - 1 378,372 - - 2
- 170,267 - 271,045
- 208,105 - 331,277
602,322
MA JASA MEDIS NON GRIU UMUM ACC

Dr. ALI RACHMAN, Sp.OG Dr. RAHMI UTAMI, Sp.OG Dr. WONGSO, Sp.OG
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - - - - - -
- - - -
- - - -
-
ERIMA JASA MEDIS GRIU UMUM ACC
Dr. ALI RACHMAN, Sp.OG Dr. RAHMI UTAMI, Sp.OG Dr. WONGSO, Sp.OG
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - - - - - -
- - - -
- - - -
OK
OK BEDAH OK OBGYN
ORTOPEDI
7,491,664 - 2,678,714
1,964,251 - 702,336
2,465,309 - 881,494
305,672 - 109,296
12,226,896 - 4,371,840
PENGURANGAN
MEDIS & JAMPERSAL
Dr. CHUSNUL GHAIB, Sp.B -
Dr. ARYA RESI P, SpB -
r. SYAIFUL KAMIL, M.Kes. Sp.B 100,778 ANASTESI
dr. RINANTI S, Sp.An 448,538 602,322 14,000,000 74%
Dr. ACENG APANDI, Sp.An 153,784 4,800,000 26%
Dr. ALI RACHMAN, Sp.OG - 18,800,000 100%
Dr. RAHMI UTAMI, Sp.OG 170,267
Dr. WONGSO, Sp.OG -
ASISTEN ANASTESI 331,277 43,589 LAMA 4 Org

602,322 39,230 BARU 2 Org
39,230 BARU 1 Org
39,230 BARU 1 Org
271,045
331,277
- BARU 1 Org
-
-
- BARU 1 Org
-
-
OK SENTRAL
EMERGENCY ELEKTIF PEMBULATAN EMERGENCY ELEKTIF
(100%)
KECIL 2,175,120 1,900,080 KECIL 2,175,120 1,900,080
SEDANG 2,725,100 2,375,100 SEDANG 2,725,100 2,375,100
BESAR 3,674,940 3,200,000 BESAR 3,674,940 3,200,000
KHUSUS 4,425,120 3,850,080 KHUSUS 4,425,120 3,850,080
100% KLIM
60% JASPEL OK BEDAH % RIIL

OK BEDAH 1,305,000 USNUL GHAIB, Sp.B - 0.00%
OK ORTOPEDI - . ARYA RESI P, SpB - 0.00%
OK OBGYN 11,415,000 - 0.00%
TOTAL 12,720,000 OK OBGYN
Dr. ALI RACHMAN, Sp.OG 3,000,000 12.61%
Dr. RAHMI UTAMI, Sp.OG 20,800,000 87.39%
Dr. WONGSO, Sp.OG - 0.00%
Dr. CHUSNUL GHAIB, Sp.B - 0.00%
23,800,000 100.00%
Pendamping Dr. Ali -
Pendamping Dr. Rahmi 42,122
Pendamping Dr. Wongso -
MUNSY 189,185.91 10.28%
DADANG 1,651,248.80 89.72%
100.00%
UMUM Dr. RINANTI S, Sp.An IKUT
OK BEDAH 87% 1,820,585 OK OBGYN
K EMERGENCY - -
SE 1 280,576
BE 1 378,372 2
KHE 1 455,610
K ELEKTIF - -
S - -
B 1 329,472
KH 1 396,404
Total 5 1,840,435 2
Dr. ACENG APANDI, Sp.An IKUT

OK BEDAH 0% - OK OBGYN
K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - -
Dr. ABDUL KADIR MUNSY, TIDAK IKUT

Dr. CHUSNUL GHAIB, Sp.B 13% 277,550 OK OBGYN
K EMERGENCY - 100% 2,098,135
SE 1 280,576 KONTROL
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total 1 280,576 -
Medis 126,259 124,898
Anastesi 154,317 152,653
BPJS Dr. RINANTI S, Sp.An IKUT

OK BEDAH OK OBGYN
K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - -

OK BEDAH OK OBGYN
K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - -
Dr. RINANTI S, Sp.An TIDAK IKUT

Dr. CHUSNUL GHAIB, Sp.B OK OBGYN
K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - Total -
Medis - Medis
Anastesi - Anastesi
SPM Dr. RINANTI S, Sp.An IKUT

OK BEDAH OK OBGYN
K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - -

OK BEDAH OK OBGYN
K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - -

K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - Total -
Medis - Medis
Anastesi - Anastesi
JAMPERSAL Dr. RINANTI S, Sp.An IKUT

OK BEDAH OK OBGYN
K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - -

OK BEDAH OK OBGYN
K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - -

K EMERGENCY -
SE -
BE -
KHE -
K ELEKTIF -
S -
B -
KH -
Total - - Total -
Medis - Medis
Anastesi - Anastesi
OK SENTRAL
EMERGENCY ELEKTIF DENGAN Dr. ANASTESI NON Dr. ANASTESI
(60%)
KECIL 1,305,072 1,140,048 Medis 53.55% Medis 53.55%
SEDANG 1,635,060 1,425,060 Dr.Anastesi 17.16% 7.72%
BESAR 2,204,964 1,920,000 Asisten 16.07% Asisten 16.07%
KHUSUS 2,655,072 2,310,048 Asisten Anas 10.73% Asisten Anas 10.73%
Admin+CS 2.50% 9.44%
100.00% Admin+CS 2.50%
100.00%
BULAN : NOPEMBER 2018 (Dr. ACENG APANDI, Sp.An)

UMUM BPJS SPM TOTAL
ZAL ZAL GRIU ZAL
Dr. CHUSNUL GHAIB, Sp.B 0
Dr. ARYA RESI P, SpB 0
Dr. ALI RACHMAN, Sp.OG 0
Dr. RAHMI UTAMI, Sp.OG 0
Dr. WONGSO, Sp.OG 0
TOTAL 0 0 0 0 0
2,695,690
277,101
2,418,589
2,695,690
IKUT UMUM OK BEDAH
OK OBGYN 100% 750,208 Dr. CHUSNUL GHAIB, Sp.B Dr. ARYA RESI P, SpB
- K EMERGENCY -
- SE - 2
756,744 BE - 1
- KHE -
- K ELEKTIF -
- S -
- B -
- KH -
756,744 TOTAL - - 3
0.00% 44.30%
IKUT
OK OBGYN 0% - OK OBGYN
- Dr. ALI RACHMAN, Sp.OG Dr. RAHMI UTAMI, Sp.OG
- K EMERGENCY -
- SE -
- BE -
- KHE -
- K ELEKTIF -
- S -
- B -
- KH -
TOTAL - - -
TIDAK IKUT 0% 0%
OK OBGYN 0% -
- 100% 750,208
- KONTROL
-
-
-
-
-
-
-
- -
- -
BPJS OK BEDAH
OK OBGYN Dr. CHUSNUL GHAIB, Sp.B Dr. ARYA RESI P, SpB
- K EMERGENCY - -
- SE - -
- BE - - -
- KHE - -
- K ELEKTIF - -
- S - -
- B - -
- KH - -
- TOTAL - - - -
#DIV/0! #DIV/0!
OK OBGYN OK OBGYN
- K EMERGENCY - -
- SE - -
- BE - -
- KHE - -
- K ELEKTIF - -
- S - -
- B - -
- KH - -
TOTAL - - - -
0% 0%
OK OBGYN
-
-
-
-
-
-
-
-
-
-
-
SPM OK BEDAH
- K EMERGENCY - -
- SE - -
- BE - - -
- KHE - -
- K ELEKTIF - -
- S - -
- B - -
- KH - -
- TOTAL - - - -
#DIV/0! #DIV/0!
OK OBGYN OK OBGYN
- K EMERGENCY - -
- SE - -
- BE - -
- KHE - -
- K ELEKTIF - -
- S - -
- B - -
- KH - -
TOTAL - - - -
0% 0%
OK OBGYN
-
-
-
-
-
-
-
-
-
-
-
JAMPERSAL OK BEDAH
- K EMERGENCY - -
- SE - -
- BE - - -
- KHE - -
- K ELEKTIF - -
- S - -
- B - -
- KH - -
- TOTAL - - - -
#DIV/0! #DIV/0!
OK OBGYN OK OBGYN
- K EMERGENCY - -
- SE - -
- BE - -
- KHE - -
- K ELEKTIF - -
- S - -
- B - -
- KH - -
TOTAL - - - -
0% 0%
OK OBGYN
-
-
-
-
-
-
-
-
-
-
-
OK
Dr. ANASTESI OK BEDAH OK OBGYN
ORTOPEDI
61.27% 799,600 - 6,994,199

16.07% 209,648 - 1,833,820
20.16% 263,127 - 2,301,606
2.50% 32,625 - 285,375
100.00% 1,305,000 - 11,415,000
PENGURANGAN
MEDIS UMUM
Dr. CHUSNUL GHAIB, Sp.B #REF!
Dr. ARYA RESI P, SpB #REF!
Dr. SYAIFUL KAMIL, M.Kes. Sp.B #REF! ANASTESI
dr. RINANTI S, Sp.An #VALUE! #VALUE! 14,000,000 74%
Dr. ACENG APANDI, Sp.An #VALUE! 4,800,000 26%
Dr. ALI RACHMAN, Sp.OG #REF! 18,800,000 100%
Dr. RAHMI UTAMI, Sp.OG #REF!
Dr. WONGSO, Sp.OG #REF!
ASISTEN ANASTESI 152,653 20,086 LAMA 4 Org 53%

18,077 BARU 2 Org 24%
18,077 BARU 1 Org 12%
18,077 BARU 1 Org 12%
74,318 100%
OK BEDAH
Dr. ARYA RESI P, SpB Dr. SYAIFUL KAMIL, M.Kes. Sp.B
Dr. RUDY ISKANDAR, Sp. An
- - -
1,751,149 - -
1,180,758 - -
- 1 1,421,791 -
- - -
- - -
- 1 1,028,160 -
- 1 1,237,031 -
2,931,907 3 3,686,982 - - 6,618,889
55.70% 0.00% 100%
OK OBGYN
r. RAHMI UTAMI, Sp.OG Dr. WONGSO, Sp.OG
- -
- -
- 2 2,361,516
- -
- -
- -
- -
- -
- 2 2,361,516 2,361,516
100% 100%
AH
Dr. SYAIFUL KAMIL, M.Kes. Sp.B
-
-
-
-
-
-
-
-
- - -
#DIV/0! #DIV/0!
YN
Dr. WONGSO, Sp.OG
-
-
-
-
-
-
-
-
- - -
0% 0%
AH
-
-
-
-
-
-
-
-
- - -
#DIV/0! #DIV/0!
YN
Dr. WONGSO, Sp.OG
-
-
-
-
-
-
-
-
- - -
0% 0%
AH
-
-
-
-
-
-
-
-
- - -
#DIV/0! #DIV/0!
YN
Dr. WONGSO, Sp.OG
-
-
-
-
-
-
-
-
- - -
0% 0%
80,343
36,155
18,077
18,077
152,653
1 LIZA WULANDARI,S.Farm, Apt III 6.55% 110,380 110,380 5,519 104,861
2 MEGAWATI, Apt BLUD 4.82% 88,640 88,640 88,640
3 SUHARTIK,Apt III 5.13% 86,456 86,456 4,323 82,133
4 LINA HERAWATI, S.Farm.,Apt. BLUD 4.12% 92,351 92,351 92,351
5 LIZIYYANNIDA, S.Farm.,Apt. BLUD 0.00% - - -
6 SOFIA UNSIYAH, S.Farm.,Apt. BLUD 4.12% 69,491 69,491 69,491
7 FAUZAN ARROZI, S.Farm.,Apt. III 4.35% 73,406 73,406 3,670 69,735
8 ISTI ANAH, S.Farm.,Apt. III 4.50% 75,853 75,853 3,793 72,060
9 SRI HIDAYATI, A.Md III 4.40% 74,167 74,167 3,708 70,459
10 NOVI HERIYATIE III 3.98% 67,044 67,044 3,352 63,692
11 NUR HAYATI ( Farm ) II 3.55% 59,839 59,839 59,839
12 ASTY REDIANA III 3.69% 62,199 62,199 3,110 59,089
13 ELLY SILFIANI III 3.69% 62,199 62,199 3,110 59,089
14 LILIK NOR AFIAH II 3.29% 55,462 55,462 55,462
15 YETTI FIRANDANI III 3.88% 65,402 65,402 3,270 62,132
16 ARIESTA AINUR GAFUR III 3.45% 58,154 58,154 2,908 55,246
17 IKA YUNI SUSILOWTI, A.Md.Farm III 4.02% 67,762 67,762 3,388 64,374
18 ELVI RIRIN A, A.Md.AF III 4.02% 67,762 67,762 3,388 64,374
19 NURY SOVYARINA BLUD 2.98% 50,231 50,231 50,231
20 ABDIR RASYID AL HABIBI BLUD 2.98% 50,231 50,231 50,231
21 IKA AGUSTINE BLUD 3.12% 52,591 52,591 52,591
22 ERYKA DAMAYANTI BLUD 2.98% 50,231 50,231 50,231
23 AHMAD ANSORI BLUD 2.98% 50,231 50,231 50,231
24 TUTIK ALWIYAH, Amd.Farm. BLUD 3.12% 52,591 52,591 52,591
25 GITA METASARI, Amd.Farm. BLUD 2.21% 37,323 37,323 37,323
26 NINA FIRDA YULIANTI, S.KM BLUD 2.70% 45,512 45,512 45,512
27 R. IMAM RAMLI II 0.00% - - -
EKO WARDOYO III 1.35% 22,837 22,837 1,142 21,695
29 SAGIMAN PHL 1.70% 28,655 28,655 28,655
97.69% - -
SANITASI Final - -
PAJAK
NO NA MA GOL. BPJS I SPM JAMPERSAL JASA RAHARJA BRUTO
5% 15%
KOLEKTIF MEDIS
1 Dr. ITJA FIRDARINI, SP.PK IV 145,871 145,871 21,881
2 Drg. Hj. RINTIH AZIS IV - - -
3 Dr. H. MOH. MUJIB, Sp.D IV 145,871 145,871 21,881
4 Dr. H. KARNEDI HOMBER, Sp.M IV 145,871 145,871 21,881
5 Dr. WINARHADI, SP.S III 143,615 143,615 7,181
6 Dr. DIAN MARCIA, Sp.A IV - - -
7 Dr. DYAH PERTAMA S, Sp.THT III 143,615 143,615 7,181
8 Dr. Hj. SUHARTINAH IV - - -
9 Dr. Hj. AMITA SAFITRI IV 141,709 141,709 21,256
10 Dr. IMELDA KRISNASARI III - - -
11 Dr. SITI FATIMAH III - - -
12 Dr. TAURUS LAISARI III - - -
13 Dr. LAILA, Sp.Rad IV 141,359 141,359 21,204
14 Dr. DIDIK PERMADI III 141,359 141,359 7,068
15 Dr. DINA ISTIYANA RIDWAN III 145,521 145,521 7,276
16 Dr. SUSANTI RUSMALA DEWI III - - -
17 Dr. ISNINA CHOLIFIAH WIDY III 145,521 145,521 7,276
18 Dr. RAHADIAN AYU NUR F III 145,521 145,521 7,276
19 LIZA WULNDARI,S.Farm, Apt III 128,872 128,872 6,444
20 MEGAWATI, Apt BLUD 114,304 114,304
21 SUHARTIK,Apt III 124,710 124,710 6,235
22 Dr. RENI IRVIANA EKA TANTRI III 137,197 137,197 6,860
23 Dr. ALI RAHMAN, Sp.OG IV 166,682 166,682 25,002
24 Dr. CHUSNUL GHAIB, Sp.B III 162,170 162,170 24,326
25 Dr. RAHMI UTAMI, Sp.OG III 162,170 162,170 8,109
26 Dr. ABD. AZIS, Sp.Rad IV 139,103 139,103 20,865
27 Drg. HENNI KUSUMAWATI IV 126,616 126,616 18,992
28 Dr. ANITAWATI IV 139,103 139,103 20,865
29 Dr. H. A. RIZKA RAHADI IV - - -
30 Dr. UTOMO, SpKJ IV 139,103 139,103 20,865
31 Dr. ENDAH, Sp.PD III 134,941 134,941 6,747
32 Dr. WONGSO,SpOG III 155,752 155,752 7,788
33 Dr. DOMINICUS H, Sp.A IKS 103,724 103,724 2,593
34 Dr. ARYA RESI P, Sp.B III 159,914 159,914 7,996
35 Dr. FAZARRAHMAH, Sp.M III 122,454 122,454 6,123
36 Dr. NOVIA INDRIANI ADISTY, S III 126,616 126,616 6,331
37 Dr. RA. NIKMATILLAH RISKIN BLUD 132,860 132,860 3,321
38 Dr. AMIR FAISAL, Sp.JP TAMU 51,862 51,862 1,297
39 LINA HERAWATI, S.Farm.,Apt. BLUD 112,048 112,048
40 LIZIYYANNIDA, S.Farm.,Apt. BLUD - -
41 SOFIA UNSIYAH, S.Farm.,Apt. BLUD 112,048 112,048
42 Dr. FARDIAN YEDAKUSUMA, S III 122,454 122,454 6,123
43 Dr. SYAIFUL KAMIL, M.Kes. Sp. BLUD 147,427 147,427 3,686
PAJAK
5% 15%
44 Dr. ANDRI DWI WAHYUDI, Sp.P III 139,103 139,103 6,955
45 drg. EKHTIYANTO CAHYADI KY III 122,454 122,454 6,123
46 FAUZAN ARROZI, S.Farm.,Apt. III 122,454 122,454 6,123
47 ISTI ANAH, S.Farm.,Apt. III 122,454 122,454 6,123
48 Dr. MUH. KRIESTIAN, Sp.PD III 134,941 134,941 6,747
49 Dr. DWI ARYANINGRUM, Sp.K III 40,818 40,818 2,041
50 Dr. ROSSY MEILANI, Sp..PK III 122,454 122,454 6,123
51 Dr. AULIA FILAYATI BLUD 132,860 132,860 3,321
52 dr. ABDUL MUNSY, Sp.An, M.Ked
WKDS - - -
53 dr. TATAG NURHIDAYAT, Sp.A WKDS - -
54 dr. DEWI ASTUTI, Sp.PA TAMU - -
55 Dr. BATHRIQEL FAUZYANASWBLUD 130,604 130,604 3,265
56 Dr. IVA JAYA MARIA BLUD 130,604 130,604 3,265
57 Dr. FARAH DIANA AGUSTINA BLUD 130,604 130,604 3,265
58 Dr. KOERNIA WATY SUTRISNO BLUD 130,604 130,604 3,265
59 Dr. NOOR AREZA ADHI PRAT BLUD 130,604 130,604 3,265
60 dr. RUDY ISKANDAR, Sp.An III 155,577 155,577 7,779
-
JUMLAH 6,354,094 - - - 6,354,094 190,568 239,019
429,587
KOLEKTIF PARAMEDIS
OK BEDAH - -
1 MASDURA YUHEDI III 116,212 116,212 5,811
2 R. FATHORRAHMAN III 117,629 117,629 5,881
3 ABDULLAH MUCHLIS III 116,212 116,212 5,811
4 RAHMAD HENDRAWAN, Amd III 114,676 114,676 5,734
5 RAMLAN SUDMA HASTRAYUIII 114,557 114,557 5,728
OK OBGYN - -
6 H.BACHTIAR EFFENDI Amd. III 116,212 116,212 5,811
7 SRI SUHARTINGSIH III 117,748 117,748 5,887
8 IMAM SASMITO ,Amd.Kep III 113,140 113,140 5,657
9 RB. ABD. HAMID ,Amd.Kep III 114,676 114,676 5,734
ANASTESI - -
10 WEDI III 113,140 113,140 5,657
11 SUGIANTO III 117,748 117,748 5,887
12 MUGIAMAN EH III 116,212 116,212 5,811
13 YUSUF RIZAL HADY, A.Md III 114,676 114,676 5,734
14 ERIC ANDRIAN, S.Kep.NS III 114,676 114,676 5,734
15 HIDAYAT HARIYANTO ,Amd III 113,140 113,140 5,657
16 MOH. ALIYANTO,Amd.Kep III 110,067 110,067 5,503
17 HIDAYAT RAHMAN, Amd.Ke III 113,140 113,140 5,657
- -
ICU - -
18 ALI ACHMAD, Amd.Kep III 114,557 114,557 5,728
19 ABU SOFYAN, Amd.Kep III 104,637 104,637 5,232
20 THAHIRATUL MUNAWARAH, III 106,173 106,173 5,309
21 JONI SUPRIADIE, Amd.Kep III 103,220 103,220 5,161
22 MURNIASIH, Amd.Kep III 103,220 103,220 5,161
PAJAK
5% 15%
23 HENDRA SURIYAWAN, S.Ke III 109,008 109,008 5,450
24 SUTRISNO, Amd.Kep III 107,710 107,710 5,385
25 SU'UDIYAH, Amd.Kep III 107,710 107,710 5,385
26 NURUL FITRIYANTO, Amd.K III 103,220 103,220 5,161
27 NURUL HIDAYATI, Amd.Kep III 103,220 103,220 5,161
28 ANDI HERMAN WAHYUDI, A III 103,220 103,220 5,161
29 DEDDY PURWANTO, Amd.Ke III 103,220 103,220 5,161
30 DEDY EKAFANTRI, S.Kep.Ns III 103,101 103,101 5,155
31 HAIRATUTTAQIYAH, Amd.KBLUD 88,811 88,811
- -
PICU/NICU - -
32 SRI ASTUTIK, S.Kep.NS IV 124,834 124,834 18,725
33 AWALAH, Amd.Kep III 107,710 107,710 5,385
34 TITIK SURATIH, Amd.Kep III 103,220 103,220 5,161
35 EMI SUFIANTI, Amd.Kep III 107,471 107,471 5,374
36 MYDIYANA DAFRIYANTI, A III - - -
37 EVA SUSANTI WIDYANTINA, III 109,008 109,008 5,450
38 NUNUK RAHMAWATI, Amd. III 103,220 103,220 5,161
39 ERNAWATI, Amd.Kep III 109,008 109,008 5,450
40 AISYAH ULFA, Amd.Kep II 101,684 101,684
41 SRI WIDYAWATI, Amd.Kep III 106,054 106,054 5,303
42 SITI AMATILAH, Amd.Kep III 107,471 107,471 5,374
43 TITIN RANI ASTUTIK, Amd.K III 107,590 107,590 5,380
44 RICA RACHMAWATI, Amd.K III 106,054 106,054 5,303
45 DWI HENNY PRASETYARINI, III 109,008 109,008 5,450
46 RATNA WAHYUNI, Amd.Kep III 103,220 103,220 5,161
47 SRI SURYATNI, Amd.Kep III 107,471 107,471 5,374
48 UTAMI KURNIAWATI, Amd. III 107,471 107,471 5,374
49 ISNAWATII, AMd. Kep III 103,220 103,220 5,161
50 HIDAYATUL FITRIYAH, AmdBLUD 88,811 88,811
51 ANIYAH, A.Md.Kep BLUD 88,811 88,811
52 SITI MUAWANAH, Amd.Kep BLUD 88,811 88,811
53 ARIFATUL KHAIR, Amd.Kep III 103,220 103,220 5,161
54 NURUL FADLILAH, A.Md.Ke BLUD 88,811 88,811
- -
IRD - -
55 NURUL SYAMSI, S.Kep.Ns III 117,629 117,629 5,881
56 ABD. RACHMAN CANDRA ,A III 107,710 107,710 5,385
57 SUHARIONO BASUKI ,Amd.K III 106,173 106,173 5,309
58 RB ACH TAUFIK ,Amd.Kep III 103,220 103,220 5,161
59 AINUR FARID ,Amd.Kep III 106,173 106,173 5,309
60 FAIZAL RIZA ,Amd.Kep III 107,710 107,710 5,385
61 WEGI APRILIANSYAH ,Amd. III 104,756 104,756 5,238
62 ANNIKA PARISTIAWATI, AM III 103,220 103,220 5,161
63 IKE YULIANTI, S.Kep.Ns BLUD 90,347 90,347
64 JUNAIDI, Amd.Kep III 104,637 104,637 5,232
65 AHMAD KURNIAWAN, Amd. III 104,637 104,637 5,232
PAJAK
5% 15%
66 ACH. SUFANDI, AMd.Kep III 104,756 104,756 5,238
67 FAISOL ULUM, S.Kep.NS III 104,756 104,756 5,238
68 ACHMAD TAUFIKUL IKSAN, BLUD 88,811 88,811
69 RETNO AFRIADI, A.Md.Kep BLUD 88,811 88,811
70 DEKI ARIYANTO, S.Kep.Ns BLUD 90,347 90,347
71 ZAINAH AMd.Kep II 100,148 100,148
72 KHAIRATUL IMAMAH, A.Md BLUD 88,811 88,811
73 NY. SITI ALPIYAH, Amd. Keb III 100,148 100,148 5,007
74 NY. HENNY RAHMAWATI S, III 100,148 100,148 5,007
IRD (118) - -
75 REZA ZAINURI ALIM, S.Kep. BLUD 90,347 90,347
76 HENDRI GUNAWAN, A.Md.K BLUD 88,811 88,811
- -
VK - -
77 Hj. RUKAYYAH, AMd. Keb III 113,021 113,021 5,651
78 Hj. AINIYAH ULFAS, A.Md, III 104,756 104,756 5,238
79 SRI WAHYUNI II 104,756 104,756
80 FENTY ZAKIYA, AMd. Keb II 101,684 101,684
81 KARSINI, AMd. Keb III 103,220 103,220 5,161
82 YULIYATIN, AMd. Keb III 103,220 103,220 5,161
83 SUCI WULANDARI, AMd.Keb III 100,148 100,148 5,007
84 ERMA DWI RISKIHATI, AMd. III - - -
85 SUSILOWATI,S.ST III 101,684 101,684 5,084
86 HAERANI, AMd.Keb III 100,148 100,148 5,007
87 YULI ASTUTIK, AMd.Keb III 100,148 100,148 5,007
88 FARIHA, A.Md.Keb BLUD 88,811 88,811
89 INES FERANITA SISTOURINI BLUD 88,811 88,811
90 NOFITA ANGGRAINI, A.Md. BLUD 88,811 88,811
91 DYANATUR RASYIDAH, A.MBLUD 88,811 88,811
92 FARIDAH, A.Md.Keb BLUD 88,811 88,811
93 FIFIN SUNDARI, A.Md.Keb BLUD 88,811 88,811
94 MISYUNI, A.Md.Keb BLUD - -
95 MULYA YULI RAHAYU, A.M BLUD 88,811 88,811
96 SARWENDAH KUSUMA W, ABLUD 88,811 88,811
97 NUR SOFI RUSYANTI A, A.M BLUD 88,811 88,811
98 RIAS ADRI PRAJAYANTI, Am III 100,148 100,148 5,007
99 IRMA SUSANTI, Amd. Keb II 100,148 100,148
- -
RUANG BEDAH - -
100 MOH. KAMIM, S.Kep.NS III 119,165 119,165 5,958
101 WIWIN APRIYANTI, Amd.Ke III 104,637 104,637 5,232
102 IRWIN DAHLIARSIH, Amd.Ke III 103,220 103,220 5,161
103 DINCE DAMAYANTI, Amd.K III 104,756 104,756 5,238
104 HERLINA NINGSIH, Amd.Kep III 104,756 104,756 5,238
105 IRWAN SUGIANTO, Amd.Kep III 103,220 103,220 5,161
PAJAK
5% 15%
106 SITI NURHAYATI, Amd.Kep III 107,710 107,710 5,385
107 IMA KHOSAIMA, Amd.Kep III 103,220 103,220 5,161
108 EMMY DWI SETIAWATI, Amd III 103,220 103,220 5,161
109 JONI SUHARTONO, S.Kep.Ns III 104,756 104,756 5,238
110 UMAR SAID, S.Kep.Ners III 100,148 100,148 5,007
111 SUCI AINI GALUH A, Amd.K III 103,220 103,220 5,161
- -
RUANG ANAK - -
112 YULIASTRI, Amd.Kep III 116,093 116,093 5,805
113 FREDDY SEPTA WASUDY, A III - - -
114 IRYANTI ISTIQOMAH, Amd. II 104,756 104,756
115 JONI HARIYANTO, S.Kep.Nes III 106,173 106,173 5,309
116 HENDRI FEBRIYANTO, Amd. III 103,220 103,220 5,161
117 SUMIYATI, Amd.Kep III 104,756 104,756 5,238
118 EKO PRASETYO A, S.Kep.NS BLUD 90,347 90,347
119 SITI AISYAH, A.Md.Kep III 100,148 100,148 5,007
- -
RUANG INTERNA - -
120 ERMAWATI, S.Kep.NS III 117,629 117,629 5,881
121 IZZUL HILAL, S.Kep.Ns III 106,173 106,173 5,309
122 KUSTIANINGSIH, Amd.Kep III 103,220 103,220 5,161
123 SITI SUBAIDAH, AMd.Kep III 103,220 103,220 5,161
124 SRI DIANA INDRA DEWI, Am III 103,220 103,220 5,161
125 NANI KARTIKA, AMd. Kep II 98,969 98,969
126 SOFIA LOREN BLUD 90,347 90,347
127 NUR HASANAH, AMd.Kep III 104,756 104,756 5,238
128 HENNY LISTIANINGSIH, AM III 106,292 106,292 5,315
129 AIDA KUSUMA DEWI, Amd.K III 104,756 104,756 5,238
130 SRI SUHERLINA, Amd.Kep III 103,220 103,220 5,161
131 SUGIANTO, Amd.Kep III 103,220 103,220 5,161
132 DAUD SULAIMAN, Amd.Kep III 100,148 100,148 5,007
133 SRI MULYANI, AMD. Kep III - - -
- -
RUANG DAHLIA - -
134 MUNAWAR, S.Kep.NS III 116,093 116,093 5,805
135 YULI HERLINA NINGSIH, Am III 103,220 103,220 5,161
136 MARIA ULFA, Amd.Kep III 103,220 103,220 5,161
137 SUSANTO WAHYUDI, Amd.K III 103,220 103,220 5,161
138 HAMDANI PRAYETNO, Amd. III 104,756 104,756 5,238
139 IKE DINA NOVIATIN, Amd.K III 103,220 103,220 5,161
140 SEMI FUJI, Amd.Kep III 103,220 103,220 5,161
141 RA.SITI ROHANI II 104,756 104,756
142 ROBIHAH, Amd.Kep III 103,220 103,220 5,161
143 SRI RAHAYU NINGSIH, Amd. III 103,220 103,220 5,161
144 BUSTOMI ARIFIN, Amd.Kep III 103,220 103,220 5,161
PAJAK
5% 15%
145 AMIR HASAN ,Amd.Kep III 103,220 103,220 5,161
146 RASUL HIDAYAT III 103,220 103,220 5,161
147 RONI AGUS WINDRIYANTO,BLUD 88,811 88,811
148 SEPTARINA PARAMITHA, S.K
BLUD - -
149 ISTIQOMATUS SHALIHAH, ABLUD - -
- -
GRIU - -
150 SIGIT SETIAWAN, S.Kep.Ns III 124,595 124,595 6,230
151 AZIZAH, AMd.Kep II 107,471 107,471
152 CICI ROSIDAH, AMd.Kep III 106,054 106,054 5,303
153 ENY YUNIARSIH, S.Kep.Ns III 109,008 109,008 5,450
154 RB. ACH. HIDAYAT, AMd.Ke III 106,054 106,054 5,303
155 Hj. HOLISATUL JANNAH, AM III 106,054 106,054 5,303
156 YULIA AFIDATUL, AMd.Kep III 106,054 106,054 5,303
157 IMAM WAHYUDI, AMd.Kep III 106,054 106,054 5,303
158 DEWI YULISTIKA, AMd.Kep III 107,471 107,471 5,374
159 Hj. ISTRI II 107,590 107,590
160 SITI JAMILAH, AMd.Kep III 106,054 106,054 5,303
161 LINDA RUSTIANI, AMd.Kep III 106,054 106,054 5,303
162 QURRATUL AINI, AMd.Kep III 106,054 106,054 5,303
163 RAFIKA KURNIA, AMd.Kep III - - -
164 FITRIA, S.Kep.Ns III 109,008 109,008 5,450
165 SRI MULYANI, AMd.Kep III 109,008 109,008 5,450
166 SRI PUJI ASTUTIK, AMd.Kep III 106,054 106,054 5,303
167 SUSIYATI, S.Kep.Ns III 109,008 109,008 5,450
168 WEMIKA DEWI, AMd.Kep III 107,471 107,471 5,374
169 JENNI CHANDRA, AMd.Kep III 109,008 109,008 5,450
170 YUM'AINI, AMd.Kep III 107,471 107,471 5,374
171 FRIESTY DYAN, Amd.Kep III 102,982 102,982 5,149
172 BAHTIAR YULIANSYAH ,Am III 107,590 107,590 5,380
173 HARMINI, A.Md.Kep III 102,982 102,982 5,149
174 ISTIQOMATUS SHALIHAH, ABLUD 91,645 91,645
175 DENI PEBRIANTO, S.Kep.Ns BLUD 93,182 93,182
176 YAYUK IKA FARIDAWATI, ABLUD 91,645 91,645
177 MUHAMMAD WILDAN FARID, BLUD 91,645 91,645
178 EKRAL RAMADHONA, S.KepBLUD 93,182 93,182
179 YENI AGUSTINA, A.Md.Kep BLUD 91,645 91,645
180 DWI SOFIRA II 106,054 106,054
181 UMMI SUSTIANA, Amd.Kep III 106,054 106,054 5,303
182 SEPTIADI TRI FERDIAN, S.KeBLUD 93,182 93,182
183 SEPTARINA PARAMITA A, S.BLUD 93,182 93,182
184 HIDAYATUR RAHMAN, Amd. III 102,982 102,982 5,149
185 NUKE WAHYUNINGTYAS, A II 102,982 102,982
186 MARIYATUL KIPTIYAH III 109,127 109,127 5,456
187 DIAH INDRIYANI, Amd.Kep III 102,982 102,982 5,149
PAJAK
5% 15%
- -
LABORAT - -
188 NURUL HERLINA III - - -
189 ALFI NURUL MARHAMAH III 116,093 116,093 5,805
190 YAYUS SUGIARTI NINGSIH, III 103,220 103,220 5,161
191 DEWI RATIH WIDIYANTI, A III 103,220 103,220 5,161
192 WARISA NOVITA SARI, A.Md III 101,684 101,684 5,084
193 ANIS HALIMIYAH, A.Md III 101,684 101,684 5,084
194 NURUL FITRIYAH, Amd III 103,220 103,220 5,161
195 DEBRINA KARTIKA SARI, A III 101,684 101,684 5,084
196 HENDRI BUDIONO BLUD 91,884 91,884
197 JAMILA,Amd.AK BLUD 88,811 88,811
198 LISA MEILANA,Amd.AK BLUD 88,811 88,811
- -
POLI INTERNA - -
199 SUMARTINI III 111,961 111,961 5,598
200 JAMI'AH III 102,041 102,041 5,102
- -
POLI GIGI - -
201 PRITTA SAHADATINA, A.Md. III 108,888 108,888 5,444
202 RUSTAM III 95,897 95,897 4,795
203 SHAFRIN HAMIDAH, A.Md.Ke III 94,360 94,360 4,718
- -
POLI KUK - -
204 RIRIN SATARIYAH IV 119,165 119,165 17,875
- -
POLI MATA - -
205 MUH. NUR HIDAYAT BUDI S IV 114,795 114,795 17,219
206 ADET MARIYANTO,S.Kep III 103,339 103,339 5,167
207 MERI HADIYATI III 102,041 102,041 5,102
- -
POLI KANDUNGAN - -
208 TAJUN NISAK III 113,497 113,497 5,675
209 NURHAYATI, AMd. Keb II 101,803 101,803
210 MARIA ULFA II - -
- -
HD - -
211 M A F R U D A H, A.Md,Kep III 111,961 111,961 5,598
212 ZAID MAHMUD, A.Md,Kep III 102,041 102,041 5,102
213 SUBAIDAH III 102,041 102,041 5,102
214 R.M. DJAUHARI, A.Md,Kep III 100,505 100,505 5,025
215 QURAISYIN, Amd.Kep III 98,969 98,969 4,948
216 ABD. HAMID, AMd.Kep III - - -
217 RAFIATUL ADAWIYAH, Amd III 97,433 97,433 4,872
- -
PAJAK
5% 15%
POLI SYARAF - -
218 SUMIYATI III 114,795 114,795 5,740
219 M U N I R A III 101,803 101,803 5,090
- -
POLI ANAK - -
220 ENDANG TEGOWATI, Amd. K III 111,961 111,961 5,598
- -
POLI THT - -
221 CICIK ERNANINGSIH III 111,961 111,961 5,598
222 Hj. INDAYANI, AMd.Kep III 102,041 102,041 5,102
- -
POLI BEDAH - -
223 LISTRIYANINGSIH III 111,961 111,961 5,598
224 SITI MAISARAH III 104,875 104,875 5,244
225 SONY LAKSONO II 103,339 103,339
- -
RADIOLOGI - -
226 ENDANG ASTIKOWATI, A.M III 113,140 113,140 5,657
227 ATIEK NOORMASARI, A.Md III 101,684 101,684 5,084
228 HIDAYATUR R, AMd. Rad III 100,148 100,148 5,007
229 NOVI NUR HAYATI, AMd. Ra III 100,148 100,148 5,007
230 EKA SRI WAHYUNI, AMR BLUD 88,811 88,811
- -
REHAB MEDIK - -
231 NANANG HERU SUMARSON IV 113,497 113,497 17,025
232 SITI RAHMANIYAH, A.Md III 97,433 97,433 4,872
233 ASRIYANAH, A.Md.Fis III 97,433 97,433 4,872
- -
INSTALASI GIZI - -
234 HAIRUNNISYAK III 120,463 120,463 6,023
235 NUR'AINI III 110,425 110,425 5,521
236 SALAMET HARIYADI III 117,510 117,510 5,875
237 MARZUKI III 111,961 111,961 5,598
238 LAILATUL ISRAWIYAH, AMd III 103,220 103,220 5,161
239 RATRI PURWANI, SST III 111,723 111,723 5,586
240 RINA WASESA APRILIANA, BLUD 90,347 90,347
241 NOERYDA PRAMUDYA, S.G BLUD 90,347 90,347
242 SUSANTIN FAJARIYAH, AMd III 85,977 85,977 4,299
243 ERMA ASTUTI, AMd.Gz III 84,441 84,441 4,222
- -
APOTIK - -
244 SRI HIDAYATI, A.Md.AF III 107,471 107,471 5,374
245 NOVI HERIYATIE III 104,399 104,399 5,220
246 NUR HAYATI II 104,399 104,399
247 ASTY REDIANA III 105,935 105,935 5,297
PAJAK
5% 15%
248 ELLY SILFIANI III 104,399 104,399 5,220
249 LILIK NOR AFIAH II 104,399 104,399
250 YETTI FIRANDANI II 104,399 104,399 5,220
251 ARIESTA AINUR GAFUR II 101,327 101,327 5,066
252 IKA YUNI SUSILOWTI, A.Md III 104,399 104,399 5,220
253 ELVI RIRIN A, A.Md.AF III 104,399 104,399 5,220
254 NURY SOVYARINA BLUD 85,739 85,739
255 ABDIR RASYID AL HABIBI BLUD 85,739 85,739
256 IKA AGUSTINE, A.Md.AF BLUD 88,811 88,811
257 ERYKA DAMAYANTI BLUD 85,739 85,739
258 AHMAD ANSORI BLUD 85,739 85,739
259 TUTIK ALWIYAH, Amd.Farm.BLUD 88,811 88,811
260 GITA METASARI, Amd.Farm. BLUD 59,208 59,208
- -
SANITASI - -
261 WARTATIK WARDANINGSIH, III 106,054 106,054 5,303
262 ERLIN SUPRAPTI, Amd. KL III 104,637 104,637 5,232
263 SUMARSIH, Amd. KL III 101,684 101,684 5,084
- -
CSSD - -
264 MOH. RUSLAN ,Amd.Kep II 104,756 104,756
-
POLI VCT - -
265 RAFIDATUL RISKIYAH III 103,220 103,220 5,161
- -
POLI JIWA - -
266 NUR HIDAYAT III 103,458 103,458 5,173
267 BAMBANG RUDIYANTO II 93,301 93,301
- -
POLI JANTUNG - -
268 ENDANG WULANDARI, A.Md III 97,314 97,314 4,866
- -
POLI PARU - -
269 IKE WULANDARI, Amd.Kep III 113,140 113,140 5,657
270 ERLYN WAHYUNI III 101,684 101,684 5,084
- -
POLI KULIT & KELAMIN - -
271 NURUL IZZATI, Amd. Kep III 111,961 111,961 5,598
- -
JUMLAH 26,804,530 - - - 26,804,530 1,024,099 70,844
KOLEKTIF NON MEDIS

KEUANGAN - -
1 SURYO KUSUMO III 90,701 90,701 4,535
2 MOH. ANSORULLAH III 91,069 91,069 4,553
PAJAK
5% 15%
3 IBNU III 93,077 93,077 4,654
4 FERI SUDARWADI III 94,357 94,357 4,718
5 YANUAR PUTRA BLUD 71,065 71,065
6 JOHNI ERIYANTO III 93,169 93,169 4,658
7 ACH. BUHARI III 90,885 90,885 4,544
8 AINUR SUBHAN II 86,132 86,132
9 AGUS YANTO II 86,132 86,132
10 MOHAMMAD TAYYIB III 90,885 90,885 4,544
11 JAKA ARDINATA RAHMAN, BLUD 69,877 69,877
12 SYAIFUL MAKRUF III 92,073 92,073 4,604
13 MOH. ROBBI ARONI, SH BLUD 69,877 69,877
- -
14PERENCANAAN & PROGRAM - -
15 DHODY ROFSANJANI SKM III 85,405 85,405 4,270
16 SURYANI RAHMANINGSIH, BLUD 69,877 69,877
17 NOVITA TRI SUPRIYANTI, S BLUD 69,877 69,877
- -
PELAYANAN - -
18 AYU SITO RESMI II 79,556 79,556
19 ACH. REZA FACHRIZIE II 79,556 79,556
20 ENDANG SRI WAHYUNI III - - -
- -
SIM RS - -
21 MOH. FERYADI ST III 90,977 90,977 4,549
22 EDI WIDIYANTO II 79,556 79,556
23 MOH. FIRMAN ARIF, S.Kom BLUD 69,877 69,877
24 IRMA OCTARINA, A.Md BLUD 68,689 68,689
25 NILA AYU SULISTIAWATI, BLUD 68,689 68,689
- -
INEV - -
26 SINTA APRILIA LUSIANTI III 84,309 84,309 4,215
- -
PENUNJANG - -
27 DEWI SUSYLOWATI III 84,309 84,309 4,215
28 FERIYANTO III 80,745 80,745 4,037
- -
SDM - -
29 SUHARTONO MAHMUD II 85,497 85,497
30 MUHARTO II 79,556 79,556
31 RA. DINA NOVIANA III - - -
32 FATHORRAHMAN II 84,309 84,309
33 RIZAL KHAIRIL SALAM II 86,501 86,501
34 MUSAHWI II 79,556 79,556
35 ERRY SRI WIDAJATI III 83,121 83,121 4,156
36 MOH. FADLI BLUD 65,124 65,124
PAJAK
5% 15%
37 MOCH. NUR JULIANTO, S.K BLUD 69,877 69,877
- -
INSTALASI GIZI - -
38 HANIYAH II 81,933 81,933
39 ARFANIYAH II 81,933 81,933
40 INDARYATI II 81,933 81,933
41 YULISTIANA II 76,361 76,361
42 NINGRIANI II 75,172 75,172
43 WIDIANING ASTUTIK II 68,597 68,597
44 FRIDA NIRWANINGSIH IKS 69,692 69,692
- -
ADM GABUNGAN POLI - -
45 Drs. ABD. LATIF III - - -
46 FANDI II 76,268 76,268
47 SUJONO II 75,080 75,080
48 SURAIDA BLUD 65,124 65,124
- -
MEDICAL RECORD - -
49 ABDUL FARID, A.Md,PK III 83,029 83,029 4,151
50 DEVI MERYL III 80,745 80,745 4,037
51 DESY PURNAMA PRATIWI, BLUD 68,689 68,689
52 AMALIA HIDAYATI, A.Md,R BLUD 68,689 68,689
53 LUTFIE, A.Md.RMIK BLUD 68,689 68,689
- -
FILLING SYSTEM - -
54 MOH. AMIN II 79,556 79,556
55 SAMSUNI II 80,652 80,652
56 AGUS HIDAYAT II 72,980 72,980
- -
IPP - -
57 VINDA SARTIKA BASRI, S. III 86,501 86,501 4,325
58 HERMAN WAHYUDI, S.I.Ko BLUD 69,877 69,877
59 R MASNGABAI NURMUHA III 83,029 83,029 4,151
- -
FRONT OFFICE - -
60 HENDRIK III 89,789 89,789 4,489
61 BAGUS BUDI DARMO, SH III 84,309 84,309 4,215
62 SLAMET MULYADI II 79,556 79,556
63 KAMARUDIN, SE III 85,497 85,497 4,275
64 YUDIONO II 79,556 79,556
65 AKHMAD FAUZI III 86,593 86,593 4,330
66 DONI WIJAYANTO III 79,556 79,556 3,978
67 SURYADI II - -
68 FIKAYATUS SHALIHAH BLUD 65,124 65,124
69 RINI PURWATI BLUD 65,124 65,124
PAJAK
5% 15%
70 ROBIATUL AULIYAH BLUD 65,124 65,124
71 TIZAN RAMDANI PUTRA BLUD 65,124 65,124
72 RASIDI III 85,497 85,497 4,275
73 WAWAN BLUD 66,312 66,312
- -
LOGISTIK - -
74 MUHAMMAD ZAINUDIN III 86,501 86,501 4,325
75 YULIASTIN SE III 78,921 78,921 3,946
76 SUTRISNO III 81,656 81,656 4,083
- -
IPS - -
77 HERMANTO,SST III 87,413 87,413 4,371
78 R.B. AINOR RACHMAN II - -
79 ANITA HARIANI,AMD.Tek.M III 83,029 83,029 4,151
80 HARTONO EKO PRASETIO, III 79,925 79,925 3,996
81 MUH. ALI III 81,841 81,841 4,092
82 ACHMAD NUR FAUZI BLUD 66,312 66,312
83 ASMUNI II 75,357 75,357
- -
SANITASI - -
84 FATHORRAHMAN II 68,597 68,597
- -
CSSD -
85 SUCIPTO II 77,457 77,457
86 BUDIYANTO II 76,268 76,268
87 SUKIRNO II 75,357 75,357
88 RB. ABD. RAHMAN II 75,357 75,357
-
LAUNDRY - -
89 MISNAWI II 75,357 75,357
90 ABUYASID II 72,980 72,980
91 AGUS RIADI II 74,169 74,169
92 KARTINA II - -
- -
KAMAR JENAZAH - -
93 SAMSUL ARIFIN III 79,741 79,741 3,987
94 AFI SAPUTRA II 72,980 72,980
95 AGUS DARMAWAN BLUD 65,124 65,124
96 MUSAHERI BLUD 65,124 65,124
97 NORITA HENDRO IRAWAN BLUD 66,312 66,312
- -
ADMINISTRASI & CLEANING SERVICE - -
98 WAHYUDI KAMIL (ADM O II 79,556 79,556
99 SUHERMANTO (HELPER) II 81,933 81,933
100 EDY SUCIPTO (CS OK) II 79,556 79,556
PAJAK
5% 15%
101 ABDURRAHMAN (CS OK) II 79,556 79,556
- -
102 ASRIYANTO (ADM RADIOLO III 77,733 77,733 3,887
- -
103 NOVITA RAHAYU (ADM LAB III 77,733 77,733 3,887
104 MOH. SALEH (CS LAB) II 81,933 81,933
- -
105 NURHADI (CS HD) II 72,980 72,980
- -
106 SLAMET HARYONO (ADM R. II 82,209 82,209
107 SUJARWO (CS ICU) II 72,980 72,980
- -
108 DEWI SUPRIYATIN (ADM R. III 77,733 77,733 3,887
- -
109 SUDARTO (ADM Z. INTERNE II 72,980 72,980
110 R. MOH. FAJAR ALAMSYAH II 72,980 72,980
- -
111 MAYA FAIRUSTIN (ADM Z. III 77,733 77,733 3,887
- -
112 FATHORRAHMAN (ADM Z. III 77,733 77,733 3,887
- -
113 DWI MEGA WIDYANINGSIH II 79,556 79,556
114 MOH. ISMAIL (HELPER) II 75,172 75,172
- -
115 RATNA DEWI AGUSTIN (ADM II 85,497 85,497
116 FAUZA BLUD 65,124 65,124
117 ABD. RASID (CS IRD) II 80,745 80,745
118 MOH TOHED (CS IRD) II 80,745 80,745
119 HERMANTO (CS IRD) II 79,556 79,556
120 MISRAWI (CS IRD) II 80,745 80,745
121 JUMADIN (CS IRD) II 79,556 79,556
- -
AMBULANCE - -
122 ADNAN II 84,125 84,125
123 MOHAMMAD AMIN II 81,933 81,933
124 DASRO PRIYANTO II 80,745 80,745
125 SUKARDI II 80,745 80,745
126 JUMA'IDIN II 75,357 75,357
127 SASMITO III 85,497 85,497 4,275
128 ROBIYANTO II 80,745 80,745
129 ZAIFUL RAHMADI BLUD 72,888 72,888
130 ATMAWI II - -
131 JOKO BUDIARSO BLUD 71,700 71,700
132 MUHAMMAD WILDAN SHA BLUD 65,124 65,124
133 AKHMAD HENDRO IRAWANBLUD 72,888 72,888
PAJAK
5% 15%
134 RUSLAN AINUR ROSIDI BLUD 71,700 71,700
135 NAUFAL NAWARI BLUD 72,796 72,796
136 CHOLIQ MARYONO BLUD 71,700 71,700
137 SAMSURIADI BLUD 72,888 72,888
- -
APOTIK - -
138 NINA FIRDA YULIANTI, S.K BLUD - -
139 R. IMAM RAMLI II - -
140 EKO WARDOYO III 81,933 81,933 4,097
141 SAGIMAN (CS FARMASI) BLUD 66,312 66,312
- -
SECURITY - -
142 MOHAMMAD MUSTAFA BLUD 65,124 65,124
143 NOER SIDIK FEBRIYANTO BLUD 65,124 65,124
144 JUANDONO BLUD 65,124 65,124
145 FATHORRAHMAN BLUD 65,124 65,124
146 CHOLIF PURNOMO BLUD 65,124 65,124
147 FIRMAN BLUD 65,124 65,124
148 KADARISMAN BLUD 65,124 65,124
149 SISKA FEBRIYANZAH BLUD 65,124 65,124
150 ZAINUR RAHMAN BLUD 65,124 65,124
151 JONI ANDIKA BLUD 65,124 65,124
152 ACH. FIRMAN RAMADHAN BLUD 65,124 65,124
153 INSAN KAMIL BLUD 65,124 65,124
154 WAHYUDI ARDIANSYAH BLUD 65,124 65,124
155 ACH. FAHMIYAFI BLUD 65,124 65,124
156 ANDY SUTRISNO BLUD 65,124 65,124
157 MOH. SYAIFUL RAHMAN BLUD 65,124 65,124
158 ACHMAT SUKRON BLUD 65,124 65,124
159 ARIF IBNO FAJAR BLUD 65,124 65,124
160 MOH. IVAN RAMDHANI BLUD 65,124 65,124
161 SANTONO BLUD 65,124 65,124
162 ERWAN JULIO BLUD 65,124 65,124
163 SUTRISNO BLUD 65,124 65,124
164 IMAM ZAIROSI BLUD 65,124 65,124
165 LUTFI ARISANTO BLUD 65,124 65,124
- -
ADM & CS GRIU - -
166 ENDANG SUKARELAWATI III 81,933 81,933 4,097
167 ACH. JUNAIDI III 81,933 81,933 4,097
168 MISNAWI BLUD 65,124 65,124
- -
JUMLAH 11,974,805 - - - 11,974,805 173,430 -
RSAL
NETTO
123,990 1
- 2
123,990 3
123,990 4
136,434 5
-
136,434 6
-
120,452 7
- 8
- 9
- 10
120,155 11
134,291 12
138,245 13
- 14
138,245 15
138,245 16
122,429 17
114,304 18
118,474 19
130,337 20
141,680 21
137,845 22
154,062 23
118,237 24
107,624 25
118,237 26
-
118,237 27
128,194 28
147,964 29
101,131 30
151,918 31
116,331 32
120,285 33
129,538 34
50,565 38,913 38,913 35
112,048 36
- 37
112,048 38
116,331 39
143,742 40
NETTO
132,148 41
116,331 42
116,331 43
116,331 44
128,194 45
38,777 46
116,331 47
129,538 48
-
- 126,616 126,616 49
- 101,468 101,468 50
127,338 51
127,338 52
127,338 53
127,338 54
127,338 55
147,798 56 56
5,924,507 266,997 266,997 - - -

TOTAL KOLEKTIF
-
110,401 1
111,748 2
110,401 3
108,942 4
108,829 5
-
110,401 6
111,861 7
107,483 8
108,942 9
-
107,483 10
111,861 11
110,401 12
108,942 13
108,942 14
107,483 15
104,564 16
107,483 17
-
-
108,829 18
99,405 19
100,865 20
98,059 21
98,059 22
NETTO
103,557 23
102,324 24
102,324 25
98,059 26
98,059 27
98,059 28
98,059 29
97,946 30
88,811 31
-
-
106,108 32
102,324 33
98,059 34
102,098 35
- 36
103,557 37
98,059 38
103,557 39
101,684 40
100,752 41
102,098 42
102,211 43
100,752 44
103,557 45
98,059 46
102,098 47
102,098 48
98,059 49
88,811 50
88,811 51
88,811 52
98,059 53
88,811 54
-
-
111,748 55
102,324 56
100,865 57
98,059 58
100,865 59
102,324 60
99,519 61
98,059 62
90,347 63
99,405 64
99,405 65
NETTO
99,519 66
99,519 FAISOL ULUM, S.Kep.NS FAISOL ULUM, Amd. 67
88,811 68
88,811 69
90,347 70
100,148 71
88,811 72
95,140 73
95,140 74
-
90,347 75
88,811 76
-
-
107,370 77
99,519 78
104,756 79
101,684 80
98,059 81
98,059 82
95,140 83
- 84
96,600 85
95,140 86
95,140 87
88,811 88
88,811 89
88,811 90
88,811 91
88,811 92
88,811 93
- 94
88,811 95
88,811 96
88,811 97
95,140 98
100,148 99
-
-
113,207 MOH. KAMIM, S.Kep.NS MOH. KAMIM, S.Kep 100
99,405 WIWIN APRIYANTI, Amd.Kep WIWIN APRIYANTI, 101
98,059 IRWIN DAHLIARSIH, Amd.Kep IRWIN DAHLIARSIH, 102
99,519 DINCE DAMAYANTI, Amd.Kep DINCE DAMAYANTI, 103
99,519 HERLINA NINGSIH, Amd.Kep HERLINA NINGSIH 104
98,059 IRWAN SUGIANTO, Amd.Kep IRWAN SUGIANTO, 105
NETTO
102,324 SITI NURHAYATI, Amd.Kep SITI NURHAYATI, A 106

98,059 IMA KHOSAIMA, Amd.Kep IMA KHOSAIMA, Am 107
98,059 EMMY DWI SETIAWATI, Amd.Kep EMMY DWI SETIAWA 108
99,519 JONI SUHARTONO, S.Kep.Ns JONI SUHARTONO, S 109
95,140 UMAR SAID, S.Kep.Ners UMAR SAID, S.Kep.N 110
98,059 SUCI AINI GALUH A, Amd.Kep SUCI AINI GALUH A, 111
-
-
110,288 YULIASTRI, Amd.Kep YULIASTRI, Amd.Ke 112
- FREDDY SEPTA WASUDY, Amd.Kep FREDDY SEPTA WASUDY, Amd.Kep
104,756 IRYANTI ISTIQOMAH, Amd.Kep IRYANTI ISTIQOMAH 113
100,865 JONI HARIYANTO, S.Kep.Nes JONI HARIYANTO, A 114
98,059 HENDRI FEBRIYANTO, Amd.Kep HENDRI FEBRIYAN 115
99,519 SUMIYATI, Amd.Kep SUMIYATI, Amd.Kep 116
90,347 EKO PRASETYO A, S.Kep.NS EKO PRASETYO A, S 117
95,140 SITI AISYAH, A.Md.Kep SITI AISYAH, A.Md. 118
-
- RUANG INTERNA
111,748 ERMAWATI, S.Kep.NS ERMAWATI, S.Kep.N 119
100,865 IZZUL HILAL, S.Kep.NS IZZUL HILAL ,Amd.K 120
98,059 KUSTIANINGSIH, Amd.Kep KUSTIANINGSIH, Am 121
98,059 SITI SUBAIDAH, AMd.Kep SITI SUBAIDAH, AM 122
98,059 SRI DIANA INDRA DEWI, Amd.Kep SRI DIANA INDRA D 123
98,969 NANI KARTIKA, AMd. Kep NANI KARTIKA 124
90,347 SOFIA LOREN, S.Kep.NS SOFIA LOREN 125
99,519 NUR HASANAH, AMd.Kep NUR HASANAH, AMd 126
100,978 HENNY LISTIANINGSIH, AMd.Kep HENNY LISTIANINGS 127
99,519 AIDA KUSUMA DEWI, Amd.Kep AIDA KUSUMA DEWI 128
98,059 SRI SUHERLINA, Amd.Kep SRI SUHERLINA, Am 129
98,059 SUGIANTO, Amd.Kep SUGIANTO, Amd.Kep 130
95,140 DAUD SULAIMAN, Amd.Kep DAUD SULAIMAN, A 131
- SRI MULYANI, AMD. Kep SRI MULYANI, AMD. Kep
-
RUANG DAHLIA
110,288 MUNAWAR, S.Kep.NS MUNAWAR, S.Kep.N 132
98,059 YULI HERLINA NINGSIH, Amd.Kep YULI HERLINA NING 133
98,059 MARIA ULFA PUSPITASARI, S.Kep.Ke MARIA ULFA, Amd.K 134
98,059 SUSANTO WAHYUDI, Amd.Kep SUSANTO WAHYUDI, 135
99,519 HAMDANI PRAYETNO, Amd.Kep HAMDANI, Amd.Kep 136
98,059 IKE DINA NOVIATIN, Amd.Kep IKE DINA NOVIATIN 137
98,059 SEMI FUJI, Amd.Kep SEMI FUJI, Amd.Kep 138
104,756 RA.SITI ROHANI RA.SITI ROHANI 139
98,059 ROBIHAH, Amd.Kep ROBIHAH, Amd.Kep 140
98,059 SRI RAHAYU NINGSIH, Amd.Kep SRI RAHAYU NINGSI 141
98,059 BUSTOMI ARIFIN, Amd.Kep BUSTOMI ARIFIN, A 142
NETTO
98,059 AMIR HASAN ,Amd.Kep AMIR HASAN ,Amd.K 143

98,059 RASUL HIDAYAT RASUL HIDAYAT 144
88,811 RONI AGUS WINDRIYANTO, A.Md.Ke RONI AGUS WINDRI 145
- 146
147
-
-
118,366
107,471
100,752
103,557
100,752
100,752
100,752
100,752
102,098
107,590
100,752
100,752
100,752
-
103,557
103,557
100,752
103,557
102,098
103,557
102,098
97,833
102,211
97,833
91,645
93,182
91,645
91,645
93,182
91,645
106,054
100,752
93,182
93,182
97,833
102,982
103,670
97,833
NETTO
-
-
-
110,288 148
98,059 149
98,059 150
96,600 151
96,600 152
98,059 153
96,600 154
91,884 155
88,811 156
88,811 157
-
-
106,363 158
96,939 159
-
-
103,444 160
91,102 161
89,642 162
-
-
101,290 163
-
-
97,576 164
98,172 165
96,939 166
-
-
107,822 167
101,803 168
- 169
-
-
106,363 170
96,939 171
96,939 172
95,480 173
94,020 174
-
92,561 175
-
NETTO
-
109,055 176
96,713 177
-
-
106,363 178
-
-
106,363 179
96,939 180
-
-
106,363 181
99,632 182
103,339 183
-
-
107,483 184
96,600 185
95,140 186
95,140 187
88,811 188
-
-
96,472 189
92,561 190
92,561 191
-
-
114,440 192
104,903 193
111,634 194
106,363 195
98,059 196
106,136 197
90,347 198
90,347 199
81,678 200
80,219 201
-
-
102,098 202
99,179 203
104,399 204
100,638 205
NETTO
99,179 206
104,399 207
99,179 208
96,260 209
99,179 210
99,179 211
85,739 212
85,739 213
88,811 214
85,739 215
85,739 216
88,811 217
59,208 218
-
-
100,752 219
99,405 220
96,600 221
-
-
104,756 222
-
98,059 223
-
-
98,285 224
93,301 225
-
-
92,448 226
-
-
107,483 227
96,600 228
-
106,363 229 229
-
25,709,587
-
-
86,166 1
86,516 2
NETTO
88,423 3
89,639 4
71,065 5
88,510 6
86,341 7
86,132 8
86,132 9
86,341 10
69,877 11
87,469 12
69,877 13
-
-
81,135 14
69,877 15
69,877 16
-
-
79,556 17
79,556 18
-
-
-
86,428 19
79,556 20
69,877 21
68,689 22
68,689 23
-
-
80,093 24
-
-
80,093 25
76,707 26
-
-
85,497 27
79,556 28
- 29
84,309 30
86,501 31
79,556 32
78,965 33
65,124 34
NETTO
69,877 35
-
-
81,933 36
81,933 37
81,933 38
76,361 39
75,172 40
68,597 41
69,692 42
-
-
-
76,268 43
75,080 44
65,124 45
-
-
78,877 46
76,707 47
68,689 48
68,689 49
68,689 50
-
-
79,556 51
80,652 52
72,980 53
-
-
82,176 54
69,877 55
78,877 56
-
-
85,299 57
80,093 58
79,556 59
81,222 60
79,556 61
82,263 62
75,579 63
- 64
65,124 65
65,124 66
NETTO
65,124 67
65,124 68
81,222 69
66,312 70
-
-
82,176 71
74,975 72
77,574 73
-
-
83,042 74
- 75
78,877 76
75,929 77
77,749 78
66,312 79
75,357 80
-
-
68,597 81
-
77,457 82
76,268 83
75,357 84
75,357 85
-
75,357 86
72,980 87
74,169 88
- 89
-
-
75,754 90
72,980 91
65,124 92
65,124 93
66,312 94
-
-
79,556 95
81,933 96
79,556 97
NETTO
79,556 98
-
73,846 99
-
73,846 100
81,933 101
-
72,980 102
-
82,209 103
72,980 104
-
73,846 105
-
72,980 106
72,980 107
-
73,846 108
-
73,846 109
-
79,556 110
75,172 111
-
85,497 112
65,124 113
80,745 114
80,745 115
79,556 116
80,745 117
79,556 118
-
-
84,125 119
81,933 120
80,745 121
80,745 122
75,357 123
81,222 124
80,745 125
72,888 126
-
71,700 127
65,124 128
72,888 129
NETTO
71,700 130
72,796 131
71,700 132
72,888 133
-
-
- 134
- 135
77,836 136
66,312 137
-
-
65,124 138
65,124 139
65,124 140
65,124 141
65,124 142
65,124 143
65,124 144
65,124 145
65,124 146
65,124 147
65,124 148
65,124 149
65,124 150
65,124 151
65,124 152
65,124 153
65,124 154
65,124 155
65,124 156
65,124 157
65,124 158
65,124 159
65,124 160
65,124 161 161
-
-
77,836
77,836
65,124
11,801,375
43,435,469
TIM PEMBAGI JASA BULAN : OKTOBER 2020
555,123
NO NA MA % BRUTO PAJAK NETTO TANDA TANGAN
1 dr. ABDUL AZIZ, Sp. Rad 39.2% 217,871 32,681 185,190 1

2 SALAMET HARIYADI 38.2% 211,902 10,595 201,307 2
3 SYAIFUL ANWAR, SE 11.3% 62,675 3,134 59,541 3
4 JOHNI ERIYANTO 11.3% 62,675 3,134 59,541 4
100.0% 555,123 49,543 505,580
Mengetahui Sumenep, 10 Pebruari 2021

Direktur RSUD dr. H. Moh. Anwar Tim Pembagi Jasa Bendahara Pengeluaran
dr. ERLIYATI, M.Kes dr. ABDUL AZIZ, Sp. Rad I B N U, S. AN

NIP. 19700722 200012 2 003 NIP. 19700403 200501 1 014 NIP. 19840416 201001 1 008
JASA PELAYANAN
NON GRIU
BPJS I & SPM, JAMPERSAL

OKTOBER 2020
TIM IPCN BULAN : OKTOBER 2020
475,820
NO NA MA % BRUTO PAJAK NETTO TANDA TANGAN
1 Hj. SURATINAH 50.0% 237,910 11,896 226,015 1

2 FREDDY SEPTA WASUDY, A 50.0% 237,910 11,896 226,015 2
100.0% 475,820 23,791 452,029
368,992
Mengetahui Sumenep, 10 Pebruari 2021

Direktur RSUD dr. H. Moh. Anwar Tim Pembagi Jasa Bendahara Pengeluaran
dr. ERLIYATI, M.Kes dr. ABDUL AZIZ, Sp. Rad I B N U, S. AN

NIP. 19700722 200012 2 003 NIP. 19700403 200501 1 014 NIP. 19840416 201001 1 008
JASA PELAYANAN
NON GRIU
UMUM PEBRUARI 2020

10 Rekp Permintaan &amp; Penerimaan Gab III BPJS I OKT&#39;20

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DAFTAR PENERIMA JASA MEDIS BPJS I, SPM & JAMPERSAL (PROPORSIONAL 60%)

BULAN : OKTOBER 2020

1 Yuliastri, Amd. Kep R. ANAK - 2,449,646 2,746,755 49,500 2,687,850 - - -

dr. ERLIYATI, M.Kes dr. ABDUL AZIZ, Sp. Rad

JUMLAH TANDA TANGAN

7,933,751 1 7,933,751 7,933,751 -

9,677,997 8 9,677,997 9,677,997 -

207,900 207,900 207,900 -

Sumenep, 10 Pebruari 2021

Dr. Tabrani, SpB 6,547,503 4,365,002

Dr. Sulistyawan, SpOT - -

Dr. Tabrani, SpB 944,161 629,441

Dr. Sulistyawan, SpOT - -

Dr. Tabrani, SpB - -

Medis 1,454,310 639,540

Dr. Suhartinah ( Tim Dr ) 2,711,610 887,040

Dr. Tabrani, SpB - -

Dr. Dian Marcia, Sp.A 1,097,910 659,340

Dr.LAILA Sp Rad 2,878,842 1,919,228

Dr. Hj. Itha FirdariniSp.PK 1,974,311 1,316,208

Dr. Dian Marcia, Sp.A 49,896 33,264

Dr. Ali Rahman SpOG 176,249 117,500

Dr. H.Moh. Mujib H 169,884 113,256

Dr. H. M. Rizal S, SpB 712,800 475,200

Drg. H. Irfan Zuhri 102,700 68,467

Dr. H. Karnedi H 345,352 230,234

25 Nanang Heru S, Amd.Fis P. REHAB MEDIK 801,876 534,584

Dr. Diah P , Sp. THT 1,121,190 747,460

Dr. Moh Mujib ,SpPD - -

Dr. Suhartinah 137,380 91,587

36 Hairunnisak,Amd.Gz INST. GIZI 328,586 219,057

KE UNIT PENGHASIL TAK LANGSUNG 39,601,667 PROSENTASE UNTUK KOLEKTIF

1 Jamali, S.Si, M.Kes IV Direksi 13,200,556 1,240,648

JUMLAH 20,526,864 1,762,638

NO URAIAN BRUTO PAJAK NETTO

1 Kelompok I 20,526,864 1,762,638 18,764,226

2,341,120 1,170,560 390,187 3,901,867

1,573,602 944,161 472,080 157,360 1,573,602

4,254,552 2,552,731 1,276,366 425,455 4,254,552

562,656 337,593 168,797 56,266 562,656 5.99%

1,642,410 821,205 273,735 2,737,350

574,200 133,650 44,550 752,400

1,305,810 583,605 194,535 2,083,950

351,450 155,925 51,975 559,350

1,454,310 479,655 159,885 2,093,850

2,711,610 665,280 221,760 3,598,650

1,097,910 494,505 164,835 1,757,250

2,878,842 1,439,421 479,807 4,798,071

1,974,311 987,156 329,052 3,290,519

49,896 24,948 8,316 83,160

176,249 88,125 29,375 293,749

169,884 84,942 28,314 283,140

712,800 356,400 118,800 1,188,000

102,700 51,350 17,117 171,167

345,352 172,676 57,559 575,586

1,336,459 801,876 400,938 133,646 1,336,459 1.01%

1,121,190 560,595 186,865 1,868,649

137,380 68,690 22,897 228,967

F JML JASPEL DIREKSI JML JASPEL

1 Jamali, S.Si, M.Kes IV Menejemen 15,860,669 15,860,669

dr. ERLIYATI, M.Kes dr. ABDUL AZIZ, Sp. Rad

Uraian BPJS I SPM JAMPERSAL JASA RAHARJA Jumlah Bruto

1 Kelompok 1 26,327,428 26,327,428

2 Kel. Reveneu ( Kel. 2 ) Proporsional 98,183,513 98,183,513

10 Rekp Permintaan & Penerimaan Gab III BPJS I OKT'20

10 Rekp Permintaan & Penerimaan Gab III BPJS I OKT'20